Taking medicines if you are pregnant and have a rheumatic disease

If you have a rheumatic disease and want to get pregnant, you should plan your pregnancy. Your doctor will assess the risks of a pregnancy to you, depending on the type of rheumatic disease you have.

Seek medical advice

Risks and side effects associated with taking medicines are included as part of the planning and individual assessment. The benefits of medical treatment must be weighed against any potential risks to the child.

This applies not least to the risks associated with the use of medications. This means that the same recommendations are not always given to women with the same disease and who are taking the same medication.

The recommendations given to you by your doctor may differ from the information you will find in the package leaflet for the medicine you are prescribed.

Medication during pregnancy poses a particular challenge because consideration must be given to your unborn child as well as you. The use of medicines may be essential for the health of both you and your unborn baby, but some medicines can also be directly or indirectly harmful to the foetus.

This is precisely why it is important to plan the pregnancy and review the medicines you are taking before you get pregnant. The goal is to provide the best possible care for you without harm to your unborn child.

Some medicines can be taken by pregnant women

Some medicines can be taken by pregnant women because we are certain that they are not harmful to the unborn child. These are medicines that have been widely used for a long time, and where no harmful effects have been detected in babies born to mothers who have taken the medicine during pregnancy.

For ethical reasons, pregnant women are almost always excluded from the large-scale studies to trial new drugs. This means that safety data come from animal studies, reports of adverse reactions, studies based on patient registries and from population studies (epidemiological studies).  

Pain-relievers

For pain during pregnancy and breastfeeding, the first choice is analgesics (painkillers or pain-relievers) in which the active substance is paracetamol.

Pregnant women are recommended to take paracetamol at the lowest effective dose for as short a period of time as possible. Seek medical advice if you have chronic pain and need painkillers constantly.

Anti-inflammatory drugs (NSAIDS)

Ibuprofen is the preferred anti-inflammatory drug to take during pregnancy and while breastfeeding.

Anti-inflammatory drugs must not be taken after week 28 of the pregnancy, because they can inhibit contractions and cause bleeding. They can also affect the foetal circulatory system.

After week 20 of the pregnancy, this type of medication should only be taken if absolutely essential and on medical advice. This also applies to the use of NSAIDs applied to the skin as a gel or cream.

Always seek medical advice if you need anti-inflammatory drugs during pregnancy.

Disease-modifying antirheumatic drugs (DMARDs)

These are some of the most common medications used to treat rheumatic diseases. It is important that any medication you are taking is discussed with your specialist. The following are general recommendations only.

Methotrexate

If you are being treated with methotrexate it is important to stop taking it at least three months before you plan to become pregnant. You should use reliable contraception during this phase.

You will need to take 1 mg/day folic acid throughout your pregnancy if you have taken methotrexate within the last 12 months. You cannot breastfeed if you are taking methotrexate.

Sulfasalazine (Salazopyrin®)

Sulfasalazine (Salazopyrin®) can be taken during pregnancy and when breastfeeding. You will need to take 1 mg/day folic acid throughout your pregnancy if you are taking Salazopyrin®. If your baby was born prematurely or has jaundice, talk to your doctor if you are breastfeeding and taking Salazopyrin®.

Corticosteroids

Corticosteroids may be used as needed during pregnancy and breastfeeding on medical advice, but at the lowest possible dose and for the shortest possible time.

If you have taken oral corticosteroids (Prednisolone®) during pregnancy, you will need to be screened for gestational diabetes by your GP or midwife in week 28 of the pregnancy. You can have cortisone injections into your joints during pregnancy and while breastfeeding.

Biological medicines

An individual assessment will be made as to whether you should continue taking any bological medicines during your pregnancy and whether/when you should stop taking them..

The different biological medicines cross the placenta to varying degrees, and your doctor will decide which medicine you should take. 
Ask your doctor whether you can breastfeed when you are taking your particular biological medicine.

Plaquenil®

Plaquenil® can be taken throughout pregnancy and while breastfeeding. For patients with SLE it is very important to continue taking Plaquenil®, as it reduces the risk of exacerbations (flares) in pregnancy.

Azathioprine (Imurel®)

Imurel® can be taken during pregnancy and while breastfeeding. Your dose ymay need to be adjusted. Discuss this with your doctor.

Recommended dietary supplements in pregnancy

Folic acid

Folic acid supplementation in the first part of pregnancy is known to provide protection against birth defects. The risk of cleft lip/palate and spinal cord defects is reduced by approximately 50 per cent.

If you have taken methotrexate before you became pregnant or are taking sulfasalazine (Salazopyrin®), you should take 1 mg/day folic acid throughout your pregnancy. If you have not taken either of these, take 0.4 mg/day for the first three months of pregnancy.

Iron

Pregnant women with not enough iron in their body (low s-ferritin), should take iron supplements.

The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR)

Monday-Friday from 08:00 to 15:00

Advises both patients and health professionals.

Norsk revmatikerforbund (Norwegian Rheumatism Association)

22 54 76 00

Tuesday from 10:00 to 15:00

Wednesday from 10:00 to 15:00

Thursday from 10:00 to 15:00

Calls are answered by people with a rheumatic disease, who can give you advice and guidance.

Podcast: Revmamas

A podcast (in Norwegian) for women who have a rheumatic disease and are planning a pregnancy or are pregnant. 

You’ll find it where you usually listen to podcasts, like Spotify for example.

Trygg mammamedisin

Get advice from professionals about safe medication use during pregnancy and breastfeeding. The service is free of charge.

Nasjonal kompetansetjeneste for svangerskap og revmatiske sykdommer. Veileder i svangerskap og revmatiske sykdommer.[Internett].Trondheim: St. Olavs hospital [hentet 2021-01-04]. Tilgjengelig fra: https://www.nksr.no/medikament/

Content provided by The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR)

The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR). Taking medicines if you are pregnant and have a rheumatic disease. [Internet]. Oslo: The Norwegian Directorate of Health; updated Tuesday, October 10, 2023 [retrieved Thursday, June 20, 2024]. Available from: https://www.helsenorge.no/en/pregnancy-and-maternity-care-in-norway/pregnancy-childbirth-family-life-rheumatic-disease/taking-medicines-if-you-are-pregnant-and-have-a-rheumatic-disease/

Last updated Tuesday, October 10, 2023