Rheumatic diseases in women of childbearing years may necessitate drug treatment during a pregnancy, to control maternal disease activity and to ensure a successful pregnancy outcome. This survey is based on a consensus workshop of international experts discussing effects of anti-inflammatory, immunosuppressive and biological drugs during pregnancy and lactation. In addition, effects of these drugs on male and female fertility and possible long-term effects on infants exposed to drugs antenatally are discussed where data were available. Recommendations for drug treatment during pregnancy and lactation are given.

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Anti-inflammatory and immunosuppressive drugs and reproduction.

Centre for Rheumatology Research, UCL Division of Medicine, University College London, London, Department of Rheumatology, University Hospitals of Leicester, Leicester, Womens Health, University College London Hospital, London, Obstetrics and Gynaecology, Frimley Park Hospital, Surrey, Department of Rheumatology, University Hospital Birmingham NHS Foundation Trust, Birmingham, Department of Rheumatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK, Department of Rheumatology, Copenhagen University Hospital, Rigshospitalet, Denmark, Department of Rheumatology, Burton Hospitals NHS Trust, Burtonupon-Trent, Rheumatic and Musculoskeletal Disease Unit, Our Lady’s Hospice and Care Services, Dublin, Ireland, Department of Rheumatology, University College London Hospital, London, Department of Rheumatology, Aneurin Bevan University Health Board, Newport, UK, Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust and Division of Immunity and Infection, University of Birmingham, Birmingham, UK

/pdf/bsr-and-bhpr-guideline-on-prescribing-drugs-in-pregnancy-and-3u2r13e9b9.pdf

BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding—Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids

American Gastroenterological Association Institute Technical Review on the Use of Gastrointestinal Medications in Pregnancy

Inflammatory bowel disease in pregnancy.

Outcome of pregnancies when fathers are treated with 6-mercaptopurine for inflammatory bowel disease.

The aims of the study were to ascertain whether patients have similar a fertility rate to the background population in Leicestershire and whether they have a similar rate of congenital malformations compared to the background population in Leicestershire. Over 1400 patients were invided to participate with an overall response rate of 81% after three successive mailings. The response rate was similar for both sexes and between the disease groups. The crude infertility rate for the group was 21%. The mean number of children for the whole group was 1.7 ± 1.3 but both men and women with Crohn's disease had significantly less children than would be expected, (men with Crohn's disease 1.5, women with Crohn's disease 1.2). There were 39 children (2% of overall births) with congenital abnormalities reported by patients with inflammatory bowel disease and in 29 cases the parents reported taking sulphasalazine (Table 3). Although this figure compares well with the 1.8% reported congenital abnormality rate for Leicestershire within the patient group in this study congenital malformations were significantly related to sulphasalazine use, z = 4.3, P < 0.0001. In conclusion sulphasalazine not only as causes morphological abnormalities in spermatozoa but may increase the chances of having congenitally abnormal offspring amongst men with IBD. The effects of other 5-aminosalacylic acids have yet to be studied in detail.

The effects of chronic ill health and treatment with sulphasalazine on fertility amongst men and women with inflammatory bowel disease in Leicestershire

V. Jayanthi

Papers

The effects of chronic ill health and treatment with sulphasalazine on fertility amongst men and women with inflammatory bowel disease in Leicestershire