Connective tissue disorders and pregnancy. Recommendations for prescribing.

This report summarizes experience with drugs prescribed for women with connective tissue disorders who either are anticipating childbearing, are pregnant or are breast-feeding. Principles of maintenance therapy are the same as when nonpregnant. Comparative trials of drugs during gestation are uncommon because of a lack of sufficient case numbers. It is difficult to distinguish between any additional risks from the medication, from any other drug and from the underlying disease. Symptoms of pregnancy may mimic side effects or toxic reactions to certain drugs. Each drug crosses the placenta, and any additional risk of spontaneous abortion, malformation or stillbirth is either negligible or unproven. Potential fetal problems with long-term intrauterine exposure to these drugs may include pancytopenia, immunosuppression, craniofacial abnormalities or restricted growth. These agents are transferred into breast milk in small quantities. Descriptions are provided of perinatal outcomes after in utero exposure to prednisone, aspirin, other nonsteroidal antiinflammatory drugs, antimalarials, gold salts, methotrexate, cyclophosphamide and azathioprine.