Women with rheumatic diseases frequently need treatment throughout pregnancy and lactation. It is essential that the maternal disease be well controlled prior to, during, and after pregnancy to ensure the best possible outcome for the mother and child. Corticosteroids have been used extensively and safely in patients with rheumatic disease during pregnancy and lactation. There is considerable experience using azathioprine during pregnancy if the maternal condition requires use of a cytotoxic drug; there has been no increased risk of congenital malformations in the exposed infants. There is limited information on the safety of other medications, including 6-mercaptopurine, cyclophosphamide, and cyclosporine. Methotrexate and chlorambucil are contraindicated during pregnancy. Immunosuppressive medications such as, azathioprine, 6-mercaptopurine, chlorambucil, cyclophosphamide, cyclosporine, and methotrexate are contraindicated during lactation.
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