August 2025
August 2025
Key:
| |||
| Medication | Pre-conception | During pregnancy | Breastfeeding |
| Conventional medications | |||
| Hydroxychloroquine | ++ | ++ | ++ |
| Sulfasalazine | ++ | ++ | ++ |
| Colchicine | ++ | ++ | ++ |
| Azathioprine, 6-mercaptopurine | ++ | ++ | + Low transfer |
| Prednisone | + Taper to <20 mg/day by adding pregnancy-compatible immunosuppressants | + Taper to <20 mg/day by adding pregnancy-compatible immunosuppressants | + After a dose of >20 mg, delay breastfeeding for 4 hours |
| Cyclosporine, tacrolimus | + Monitor blood pressure | + Monitor blood pressure | + Low transfer |
| NSAIDs (cyclooxygenase 2 inhibitors not preferred) | + Discontinue if the woman is having difficulty conceiving | + Continue in first and second trimesters; discontinue in third trimester* | + Ibuprofen preferred |
| Tumor necrosis factor inhibitors (tumor necrosis factor inhibitors are considered compatible with pregnancy) | |||
| Certolizumab | ++ | ++ | ++ |
| Infliximab, etanercept, adalimumab, golimumab | + Continue through conception | + Continue in first and second trimesters; discontinue in third trimester several half-lives prior to delivery | ++ |
| Rituximab | + Discontinue at conception | + Life-/organ-threatening disease | ++ |
| Other biologics (limited safety data; limited transfer in early pregnancy but high transfer in second half of pregnancy) | |||
| Anakinra, belimumab, abatacept, tocilizumab, secukinumab, ustekinumab | + Discontinue at conception | × Discontinue during pregnancy | + Expect minimal transfer due to large molecular size, but no available data |
| Not compatible with pregnancy | |||
| Methotrexate | ×× Stop 1-3 months prior to conception | ×× Stop and give folic acid 5 mg/day | × Limited data suggest low transfer |
| Leflunomide | ×× Cholestyramine washout if detectable levels | ×× Stop and give cholestyramine washout | ×× |
| Mycophenolate mofetil and mycophenolic acid | ×× Stop >6 weeks prior to conception to assess disease stability | ×× | ×× |
| Cyclophosphamide | ×× Stop 3 months prior to conception | + Life-/organ-threatening disease in second and third trimesters | ×× |
| Thalidomide | ×× Stop 1-3 months prior to conception | ×× | ×× |
| Tofacitinib, apremilast, baricitinib | Unable to determine due to lack of data; small molecular size suggests transfer across the placenta and into breast milk | ||
NSAIDs: nonsteroidal antiinflammatory drugs.
* Adverse effects of NSAIDs on the fetus vary based on the type of NSAID, timing of exposure, dose, and duration of use. As such, some UpToDate contributors suggest a different approach to the utilization of NSAIDs during pregnancy. This is discussed in detail in related UpToDate topics on the use and risks of NSAIDs in pregnancy.
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