- Outcomes of children born to mothers with systemic lupus erythematosus exposed to hydroxychloroquine or azathioprine. [Journal Article]Rheumatology (Oxford). 2022 Jun 29 [Online ahead of print]R
- CONCLUSIONS: There were no significant negative outcomes in children exposed to HCQ in pregnancy. AZA use was associated with increased reporting of childhood infection which warrants further study.
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- Usage of Tacrolimus and Mycophenolic Acid During Conception, Pregnancy, and Lactation, and Its Implications for Therapeutic Drug Monitoring: A Systematic Critical Review. [Journal Article]
- CONCLUSIONS: Tac treatment during conception, pregnancy and lactation seems to be relatively safe. Due to pharmacokinetic changes during pregnancy, a higher Tac dose might be indicated to maintain target concentrations. However, more evidence is needed to make recommendations on both Tac dose adjustments and alternative matrices than whole-blood for TDM of Tac during pregnancy. MPA treatment in men during conception seems to have no adverse effect on pregnancy outcomes, whereas MPA use in women during conception and pregnancy is strongly discouraged.
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- Antirheumatic medications in pregnancy and breastfeeding. [Review]
- As active rheumatic and musculoskeletal disease during pregnancy increases the risk for pregnancy loss, preterm birth, and maternal illness, ongoing management with pregnancy-compatible medications can improve these outcomes. Selecting and taking these medications can be challenging for rheumatologists and patients due to limited knowledge about potential risks and benefits.
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- Immunosuppression and Reproductive Health After Kidney Transplantation. [Review]
- Following successful kidney transplantation, recipients usually regain fertility. Post-engraftment pregnancies should be planned and the teratogenic mycophenolic acid should be replaced with azathioprine before conception. To avoid unintentional pregnancies, pre-conception counseling is mandatory in women of reproductive age who are scheduled for a kidney transplant. Counseling should be repeated…
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- Pharmacological Approach to Managing Childhood-Onset Systemic Lupus Erythematosus During Conception, Pregnancy and Breastfeeding. [Review]
- Pediatric patients often have poor pregnancy outcomes. Systemic lupus erythematosus predominantly impacts women in their second to fourth decade of life, with childhood-onset disease being particularly aggressive. Reproductive issues are an important clinical consideration for pediatric patients with systemic lupus erythematosus (SLE), as maintaining good disease control and planning a pregnancy …
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- Overview of Pregnancy in Renal Transplant Patients. [Review]
- Kidney transplantation offers best hope to women with end-stage renal disease who wish to become pregnant. Pregnancy in a kidney transplant recipient continues to remain challenging due to side effects of immunosuppressive medication, risk of deterioration of allograft function, risk of adverse maternal complications of preeclampsia and hypertension, and risk of adverse fetal outcomes of prematur…
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- Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding Varies Widely: A Need for Further Education. [Journal Article]
- Background. Inflammatory bowel disease (IBD) affects patients in their young reproductive years. Women with IBD require maintenance therapies during pregnancy and breastfeeding. However, physician management of IBD during pregnancy and breastfeeding has not been well characterized. Objective. To characterize physician perceptions and management of IBD during pregnancy and breastfeeding. Methods. …
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- Breastfeeding in mothers with systemic lupus erythematosus. [Journal Article]
- CONCLUSIONS: Half of women with lupus breastfed and most desire to breastfeed. Hydroxychloroquine, azathioprine, methotrexate, and prednisone have very limited transfer into breast milk and may be continued while breastfeeding.
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- Rheumatoid arthritis medications and lactation. [Review]
- CONCLUSIONS: Many but not all RA medications may be used during lactation with low risk to the nursing infant; this review summarizes the available data for commonly used medications in order to help guide therapy during the postpartum period.
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- Update on pregnancy and breastfeeding in the era of biologics. [Review]
- Inflammatory bowel diseases are chronic conditions that frequently affect patients during their childbearing years. Considering the characteristics of disease and the medications used to treat it, several issues arise in the care of these patients when they attempt or achieve conception. We review the most current evidence concerning fertility and pregnancy outcomes in patients with inflammatory …
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- Rheumatoid arthritis and pregnancy: safety considerations in pharmacological management. [Review]
- Pregnancy can pose a challenge to the physician caring for women with rheumatoid arthritis (RA). While many women with RA experience a spontaneous improvement in joint pain and inflammation during pregnancy, in others it remains active and they continue to need ongoing therapy. It is important to tailor the treatment regimen so that the disease is stabilized prior to conception and to use medicat…
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- Long-term follow-up of babies exposed to azathioprine in utero and via breastfeeding. [Journal Article]
- CONCLUSIONS: Our study which reports the largest number of babies breastfed with exposure to AZA suggests that breastfeeding does not increase the risk of infections.
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- [Liver transplantation and pregnancy]. [Journal Article]Presse Med. 2010 Nov; 39(11):1143-9.PM
- Patients with liver failure have menstrual cycle irregularities or amenorrhea. Liver transplantation restores menstrual pattern among women with cirrhosis in childbearing years. It is now accepted that a planned pregnancy is possible among liver transplant recipients at least 1 year after liver transplantation, with stable allograft function and under immunosuppressive regimens, to minimize the r…
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- Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding. [Review]
- The aim of this article is to critically review available data regarding the safety of immunomodulators and biological therapies during pregnancy and breast-feeding in women with inflammatory bowel disease. Methotrexate and thalidomide can cause congenital anomalies and are contraindicated during pregnancy (and breast-feeding). Although thiopurines have a Food and Drug Administration (FDA) rating…
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- Inflammatory bowel diseases and management considerations: fertility and pregnancy. [Review]
- Young women with inflammatory bowel disease (IBD) pose a unique set of challenges. These women and their treating physicians must make difficult choices in matters regarding conception, pregnancy, and breastfeeding. This review highlights recent evidence and management issues that arise when taking care of women with IBD in terms of fertility, outcomes, and medication safety in pregnancy and brea…
- Azathioprine treatment during lactation. [Journal Article]
- CONCLUSIONS: The major part of 6-mercaptopurine in breast milk is excreted within the first 4 h after drug intake. On the basis of maximum concentration measured, the infant ingests mercaptopurine of <0.008 mg/kg bodyweight/24 h. The findings confirm that breastfeeding during treatment with azathioprine seems safe and should be recommended, considering the extensive beneficial effects.
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- Pregnancy and breastfeeding in patients with Crohn's disease. [Review]
- Crohn's disease commonly affects women of childbearing age. Available data on Crohn's disease and pregnancy show that women with Crohn's disease can expect to conceive successfully, carry to term and deliver a healthy baby. Control of disease activity before conception and during pregnancy is critical, to optimize both maternal and fetal health. Generally speaking, pharmacological therapy for Cro…
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- Autoimmune hepatitis among fertile women: strategies during pregnancy and breastfeeding? [Journal Article]
- CONCLUSIONS: In general, the outcome of pregnancy in women with AIH seems to be good. Current pharmacological treatment appears to be safe, including azathioprine during pregnancy and lactation. After delivery an active preparedness to increase pharmacotherapy should be considered.
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- Therapy insight: the use of antirheumatic drugs during nursing. [Review]
- In 90% of cases, women with rheumatoid arthritis suffer a disease flare within 3 months of delivery of their baby. Drug treatment is, therefore, required; however, such therapies have implications for mothers who decide to nurse their infants. Unfortunately, because of a paucity of data, little is known about the transfer of antirheumatic drugs into breast milk, and even less is known about wheth…
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- Azathioprine and breastfeeding: is it safe? [Multicenter Study]
- Traditionally, women receiving azathioprine have been discouraged from breastfeeding because of theoretical potential risks of neonatal bone marrow suppression, susceptibility to infection, and pancreatitis. The aims of this study were to measure the concentration of 6-mercaptopurine (6-MP) in breast milk of mothers receiving azathioprine and in the blood of their babies and to investigate any im…
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- Breast-feeding during maternal use of azathioprine. [Case Reports]
- CONCLUSIONS: Maternal azathioprine use during lactation does not appear to pose a significant immediate clinical risk to the suckling infant. Continued monitoring and long-term assessment of these infants are warranted.
- Exposure to thiopurine drugs through breast milk is low based on metabolite concentrations in mother-infant pairs. [Journal Article]
- CONCLUSIONS: The data suggest that azathioprine may be 'safe' during breastfeeding in patients with the wild-type TPMT genotype (approximately 90% of caucasian patients) taking 'normal' doses.
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- The use of medications for inflammatory bowel disease during pregnancy and nursing. [Review]
- Inflammatory bowel disease includes two primary disorders, ulcerative colitis and Crohn's disease. These diseases mainly affect young adults, with a peak occurrence between 15 and 25 years of age. The causes of these diseases are largely unknown, with current treatments targeted against the heightened inflammatory response witnessed in the intestinal mucosa of both conditions. With the peak age r…
- Multiple sclerosis: management issues during pregnancy. [Review]
- Care of pregnant women with multiple sclerosis (MS) is challenging because of the multiple physiological changes associated with pregnancy and the need to consider the impact of any intervention on the foetus. Pregnancy is associated with clinical MS stability or improvement, while the rate of relapse rises significantly during the first three months post-partum before coming back to its level pr…
- Inflammatory bowel disease: management issues during pregnancy. [Review]
- CONCLUSIONS: Pregnancy should be avoided in women treated with methotrexate because of its known abortifacient effects and risk of causing typical malformations. There is no actual evidence of adverse effect in pregnant women receiving Infliximab but the amount of clinical information is small. The treatment with metronidazole or ciprofloxacin for short durations appear to be safe, but there is no data about the effects of increased length of treatment as required in Crohn's disease remains unknown. Control of disease activity before conception and during pregnancy is critical to optimise both maternal and foetal health. A multidisciplined approach involving both obstetrician and gastroenterologist and education about pregnancy are essential components of the treatment of any young women with IBD.
- Drug safety issues in pregnancy following transplantation and immunosuppression: effects and outcomes. [Review]
- Successful pregnancy outcomes are possible after solid organ transplantation. While there are risks to mother and fetus, there has not been an increased incidence of malformations noted in the newborn of the transplant recipient. It is essential that there is closely coordinated care that involves the transplant team and an obstetrician in order to obtain a favourable outcome. Current data from t…
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- Connective tissue disorders and pregnancy. Recommendations for prescribing. [Review]
- 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 additio…
- Obstetric care for renal allograft recipients or for women treated with hemodialysis or peritoneal dialysis during pregnancy. [Review]
- Pregnancies in women on dialysis and in women who have had renal transplant are no longer uncommon. Optimal obstetric outcomes require a multidisciplinary team approach, patient counseling, and clinicians who are knowledgeable and experienced in taking care of these patients. Counseling should begin before pregnancy, and all reproductive age women on dialysis and who have undergone renal transpla…
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- Breast-feeding during treatment with cyclosporine. [Journal Article]
- CONCLUSIONS: Breast-fed infants of mothers treated with CsA received less than 300 microg per day of CsA and absorbed undetectable amounts. There were no demonstrable nephrotoxic effects or other side effects. Thus, women with kidney transplants could be allowed to breast-feed.
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- Drug therapy for ulcerative colitis during pregnancy. [Review]
- Women with ulcerative colitis (UC) are usually young and thus likely to undergo pregnancy. They should be advised to conceive when the disease is quiescent. Steroids and salicylates may be used normally during pregnancy, possibly without exceeding a dose of 2g/day for mesalazine. Azathioprine can be maintained if its indication is clear cut. Cyclosporin seems to be without additional risk in the …
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