An article in ACR Open Rheumatology focused on medication decision-making during pregnancy and lactation addressed some of these concerns.2 One of its co-authors, Whitney White, PharmD, BCPS, a clinical pharmacist practitioner with the Birmingham Veterans Affairs Medical Center, Ala., has rheumatoid arthritis (RA). She serves on the core leadership team for the ACR Reproductive Health Initiative and was also a guest on the podcast episode.
The research found a hesitancy to use anti-rheumatic drugs during pregnancy was common among the 66 women who were surveyed. Among the women prescribed medications considered safe during pregnancy, 80% opted not to use them while trying to become pregnant or during pregnancy or lactation.
Dr. White shared her own experience of having the option to change medications during pregnancy or stop medications completely. She chose to stop the medications and evaluate how she felt. She was able to remain off her medications during pregnancy and for a few months after delivering. But she says it’s a personal choice.
This choice is likely easier for patients with RA vs. lupus or other disorders because pregnancy may induce RA remission, Dr. Sammaritano says.
Educating Physicians
Because physicians may give patients mixed messages about which drugs are safe to use, the need exists for education across specialties to make clear which drugs are safe during pre-conception, and during pregnancy and lactation, and which ones are not. This discussion should include general practitioners, OB/GYNs, rheumatologists and pediatricians, if breastfeeding is involved, Dr. Sammaritano says.
Lactation and medications to treat rheumatic conditions were addressed in a 2021 study from Mills et al.3
“Until we reach all of the players who have a role and a voice in terms of a woman’s pregnancy and the health of her newborn, I think we’re going to have continued conflicting opinions,” Dr. Sammaritano says.
The ACR Reproductive Health Guideline addresses issues that become important during pregnancy and lactation.1
What may be helpful going forward is a small reference card that lists which drugs are safe during pregnancy or lactation that patients can share with other providers, the podcast guests say. This approach is also what was used in study by Mills et al., which found rheumatologist knowledge of medications that are safe or unsafe for breastfeeding increased with the simple use of a laminated reference card.3
Dr. White likened it to the new mother packet that patients often receive at an OB/GYN’s office when they are expecting. This packet contains a lot of information about what they will experience during pregnancy and which medications are considered safe or unsafe. Rheumatologists could provide something similar and geared toward rheumatologic medications.
