Gerosa Maria, Schioppo Tommaso, Meroni Pier Luigi
a Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini , University of Milan , Milan , Italy.
b Experimental Laboratory of Immunological and Rheumatologic Researches , IRCCS Istituto Auxologico Italiano , Milan , Italy.
Expert Opin Pharmacother. 2016 Aug;17(11):1539-47. doi: 10.1080/14656566.2016.1197204. Epub 2016 Jun 16.
Rheumatoid arthritis (RA) can spontaneously improve during pregnancy. However, a considerable proportion of patients can experience a flare and high disease activity has been associated with an increased risk of adverse pregnancy outcome. Thus, the treatment of RA in pregnant women should be selected taking into account both the potential harmful effects of the treatment and the risk associated with discontinuation.
Recent publications regarding safety of the most important disease modifying anti-rheumatic drugs (DMARDs) during pregnancy has been reviewed. A systematic literature search of MEDLINE was conducted using pregnancy, teratogenicity, adverse effects, embryo/foetal-toxicity as key search terms for each DMARD.
A great body of evidence suggest that hydroxychloroquine, sulfasalazine, and non-fluorinated steroids can be continued throughout pregnancy, while methotrexate and leflunomide should be discontinued 3 months before pregnancy. Continuation of TNFi during the first part of pregnancy should be considered when benefits outweigh the potential risk of teratogenicity. Data regarding other biologics are scant and, at present, they should be stopped before pregnancy.
类风湿关节炎（RA）在孕期可自发改善。然而，相当一部分患者会出现病情复发，且高疾病活动度与不良妊娠结局风险增加相关。因此，选择孕妇RA的治疗方法时，应兼顾治疗的潜在有害影响以及停药相关风险。
回顾了近期关于孕期最重要的改善病情抗风湿药物（DMARDs）安全性的出版物。使用妊娠、致畸性、不良反应、胚胎/胎儿毒性作为每种DMARD的关键检索词，对MEDLINE进行了系统文献检索。
大量证据表明，羟氯喹、柳氮磺胺吡啶和非氟化类固醇在整个孕期均可继续使用，而甲氨蝶呤和来氟米特应在妊娠前3个月停药。当益处超过致畸潜在风险时，应考虑在妊娠早期继续使用肿瘤坏死因子抑制剂（TNFi）。关于其他生物制剂的数据较少，目前，应在妊娠前停药。
