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Table 3 Drugs used in the treatment of autoimmune diseases/compatibility with pregnancy (adapted from Andreoli et al. [9])

From: Autoimmune diseases and pregnancy: analysis of a series of cases

Drug FDA category Permitted during pregnancy Notes
Prednisolone B Allowed Associated to medical/obstetric complications (maternal diabetes, preeclampsia, premature rupture of membranes)
NSAID B/D Allowed; avoid from 3rd trimester onward Risk of premature closure of the arterial duct in the 3rd trimester
Hydroxychloroquine C Allowed Discontinuation during pregnancy is associated with SLE exacerbations
Azathioprine D Allowed In the smallest therapeutic dosage, if benefits outweigh risks
Cyclosporine C Allowed  
Tacrolimus C Allowed  
Sulfasalazine B Allowed  
Methotrexate X Discontinue 3–6 months before a planned pregnancy  
Cyclophosphamide D Discontinue at least 3 months before a planned pregnancy  
Mycophenolatemofetil D Discontinue at least 6 weeks before a planned pregnancy  
Warfarin D Discontinue after positive pregnancy test Can be used while breastfeeding
LMWH B Allowed Used as primary prevention of thrombotic events during the puerperal period
IVIG C Allowed  
Rituximab C Discontinue at least 6–12 months before a planned pregnancy  
Belimumab C Discontinue at least 4 months before a planned pregnancy  
  1. FDA-assigned pregnancy categories (The United States Food and Drug Administration): A controlled studies in humans have failed to demonstrate a risk to the foetus, B no evidence of risk for the human species, C Teratogenic—risk to humans cannot be excluded, D clear evidence of risk to the human foetus—risk is acceptable in a situation of very high risk for the pregnant woman, in lack of safer alternatives, X Drugs considered unsafe during pregnancy.
  2. NSAID nonsteroidal anti-inflammatory drugs, LMWH low-molecular-weight heparin, IVIG intravenous immunoglobulin, SLE systemic lupus erythematosus.
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