Ostensen M
Department of Rheumatology, University Hospital of Trondheim, Norway.
Am J Reprod Immunol. 1992 Oct-Dec;28(3-4):148-52. doi: 10.1111/j.1600-0897.1992.tb00778.x.
Active rheumatic disease may necessitate the treatment of pregnant and lactating patients with disease modifying (DMARD) or immunosuppressive drugs. This review summarizes data from the literature, and attempts to give some recommendations. Possible teratogenic effects of gold, penicillamine, and chloroquine are still disputed. As long as the issue is not settled, it seems prudent to stop using these agents as soon as pregnancy is diagnosed. Hydroxychloroquine has been used by some rheumatologists for treating pregnant patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) without malformations detected in the neonates. Sulphasalazine does not increase the rate of congenital abnormalities. Selected case reports have not shown any teratogenicity of cyclosporine A so far. However, the drug may cause fetal retardation. The use of standard doses of azathioprine does not increase the risk of congenital anomalies. By contrast, the antitumor agents cyclophosphamide, chlorambucil, and methotrexate are possibly teratogenic when given during early pregnancy, but may be less harmful in late pregnancy. Data on the excretion of DMARD and the cytostatic drugs are sparse. Because of insufficient data, breast feeding is not recommended in patients on antimalarials, penicillamine, cyclosporine A, and cytostatic drugs. Intramuscular gold and sulphasalazine seem to impose no major risk on the nursing infant.
活动性风湿性疾病可能需要对妊娠和哺乳期患者使用改善病情抗风湿药（DMARD）或免疫抑制药物进行治疗。本综述总结了文献数据，并试图给出一些建议。金制剂、青霉胺和氯喹可能的致畸作用仍存在争议。只要这个问题没有解决，一旦诊断出怀孕，就停止使用这些药物似乎是谨慎的做法。一些风湿病学家使用羟氯喹治疗患有系统性红斑狼疮（SLE）和类风湿关节炎（RA）的孕妇，新生儿未检测到畸形。柳氮磺胺吡啶不会增加先天性异常的发生率。目前选定的病例报告尚未显示环孢素A有任何致畸性。然而，该药物可能导致胎儿发育迟缓。使用标准剂量的硫唑嘌呤不会增加先天性异常的风险。相比之下，抗肿瘤药物环磷酰胺、苯丁酸氮芥和甲氨蝶呤在孕早期使用时可能有致畸性，但在孕晚期可能危害较小。关于DMARD和细胞毒性药物排泄的数据很少。由于数据不足，不建议服用抗疟药、青霉胺、环孢素A和细胞毒性药物的患者进行母乳喂养。肌肉注射金制剂和柳氮磺胺吡啶似乎对哺乳婴儿没有重大风险。
