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A national survey on the use of rheumatology drugs during pregnancy
  1. S Panchal1,
  2. M Khare2,
  3. A Moorthy1,
  4. A Samanta1
  1. 1Rheumatology University Hospitals of Leicester NHS Trust, Leicester, UK
  2. 2Maternal Fetal Medicine University Hospitals of Leicester NHS Trust, Leicester, UK

Abstract

Background Drugs used by rheumatologists to control disease are not all safe during conception, pregnancy and lactation.1 No clear guidelines exist on the use of rheumatology drugs during pregnancy. We compare the current practice among rheumatologists and obstetricians across the UK.

Methods A questionnaire was devised to address individual drugs used during pre-conception, pregnancy and lactation. Members of the British Society of Rheumatology and the British Maternal Fetal Medicine Society were contacted via an electronic link. The results were analysed by the online survey software and Fisher exact testing.

Results Our results show differences between rheumatologists and obstetricians respectively. 500 members of each society were emailed. There were 102 (20%) versus 33 (7%) respondents. With regard to medication, we asked in relation to advice given before conception; hydroxychloroquine 80% versus 61% continue, 19% versus 15% discontinue (p=1.0); sulphasalazine 59% versus 70% continue, 41% versus 6% discontinue (p=0.002); azathioprine 62% versus 58% continue, 36% versus 21% discontinue (p=0.37); methotrexate 0% versus 3% continue, 100% versus 76% discontinue (p=0.2); leflunomide 0% versus 0% continue, 98% versus 42% discontinue (p=1.0); Anti-tumour necrosis factor therapy 7% versus 15% continue, 54% versus 54% discontinue (p=0.05); rituximab 2% versus 12% continue, 95% versus 52% (p=0.01) would discontinue prior to conception.

Conclusion This survey is the first of its nature among rheumatologists and obstetricians. Most would give advice to continue with sulphasalazine, azathioprine and stop methotrexate and leflunomide. We observed no uniform practice and therefore recommend guidelines.

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