TTC First Baby

[alapio]

Hello!

I'm new to this forum but am slowly reading through the various posts that are relevant to me...

I'm 27 and was diagnosed with rheumatoid arthritis almost 10 years ago now. My husband and I are currently thinking about starting a family in the next six months.

Current medications:
Adalimumab (humira) 40mg fortnightly
Hydroxychloriquine (plaquenil) 200mg BD
I was on methotrexate but haven't consistently taken it for some time due to its side effects and definitely haven't taken it at all in the last year.

I also take a variety of supplements given to me by a naturapath recently including curcuforte and flex-mend. As for any other medications, I take panadol, ibuprofen and voltaren when required and on the rare occasion, panadeine forte and oxycodone. At this stage, I take prednisolone very minimally (not in the last six months from memory) but my rheumatologist has mentioned the possible need for prednisolone during pregnancy.

I was wondering if you could offer any advice on these medications during the pre-conception/trying to conceive periods, pregnancy and breastfeeding. I have an appointment with a maternal fetal medicine specialist in the new year but thought I would see if I can get a head start on any information. I am really passionate about breastfeeding and will be absolutely heartbroken if I can't feed my newborn this way. So I'm hoping you can shine some light for me to give me some hope. I've had a quick read and it seems enbrel might be a better option than humira - should I ask my rheumatologist about switching or should I stick to what I know works for me?

Thank you so much for your time and for providing this information to us.
Alanna

[admin]

Alapio:

If you are planing a pregnancy, I would first highly recommend you start taking Folic Acid 1 mg per day, long before you become pregnant.

Two, Do not use methotrexate for at least 3 months before, and certainly never during pregnancy. It is a known teratogen.

Hydroxychloroquine has not been found to produce birth defects, but the data is limited.

Adalimumab has only minimally been studied in pregnancy. Hopefully you might be able to reduce or completely stop using it while pregnant. Its use during the first and second trimester is probably safer than in the last trimester. During the last trimester, IgG immune globulins are actively transferred to the fetus. Even with this, there is little likelihood of problems in the fetus. Remember, many immune syndromes such as arthritis or MS, actually get much better during pregnancy, which is a state of moderate immunosuppression. Hopefully, your symptoms will moderate while pregnant and you might be able to stop using it while pregnant. But if you have to use one of the monoclonal antibodies such as Adalimumab to stay healthy, by all means do so.

As for Herbal products, I do not ever recommend their use during pregnancy. We simply know nothing about their use or safety in pregnancy and I would strongly suggest you stop using them while trying to get pregnant, and during pregnancy.

Acetaminophen is commonly used in pregnant women. Ibuprofen or Voltaire are not recommended because of bleeding problems. Oxycodone, if rarely used, is OK.

Prednisolone can be used but cautiously and in moderate to low doses. There are small increased risks of oral clefts, etc, but it is commonly used in some pregnancies.

All these drugs are fine in breastfeeding except methotrexate. Do NOT use this while breastfeeding.

Good Luck

Tom Hale R.Ph., Ph.D.
Professor
Infantrisk Center

[alapio]

Hi Dr Hale,

Thank you so much for your reply. I am seriously hoping my symptoms improve during pregnancy as I would love to be on as little medication as possible. If I am on adalimumab during pregnancy and breastfeeding, is there an impact on the infant's immune system? I vaguely recall something about maybe needing to delay live vaccines? Would I have to be over cautious with other people handling babe, having her near people who are sick etc etc. I don't want to become an overanxious mother who won't let other people hold their babe, but I also don't want him/her to get sick.

Can I ask what dose of prednisolone is considered low-moderate? Is it more safely taken after 12 weeks when the cleft palate has developed?

Thank you again. I'm glad to hear they are considered okay in breastfeeding - this is a huge passion of mine and I am really hoping to be able to breastfeed.

Alanna

[Sandra]

Alapio,

Prednisone 10mg probably ok. and yes if you wait until second trimester probably safer. Vaccines should be ok as long as the infant is not immunocompromised, and I recommend keeping sick people away from new infants as much as possible anyways, but if people are not sick it should be ok.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519