In November 2022, the British Society for Rheumatology (BSR) launched two updated guidelines containing evidence and best practice for prescribing rheumatology medications during conception, pregnancy and breastfeeding. 

“The use of medications in pregnancy often causes concern. We’ve reviewed all the latest evidence in the development of these guidelines to make recommendations on using rheumatological drugs during conception, all stages of pregnancy, breastfeeding and in men who wish to conceive.”
Professor Ian Giles (leader of guidelines)

“Information is power and these guidelines are a way to really empower the patient and involve us in decision making so we understand the pros and cons of each medication we may be on. It means that we can forward plan so we can have as normal an experience of pregnancy and breastfeeding as possible.”
Clare Reid (Lay member)

What are the new guidelines?

The new guidelines update the guidance published in 2016 and cover new treatments like recent biologics and small molecule drugs. Using the latest information and evidence, the new guidelines advise on the timing of using medicines and give clinicians an important resource when treating pregnant patients. 

The guidelines were developed by members from rheumatology and other wider working groups made up of obstetricians, obstetric physicians, pharmacists, GPs and patients.

The guidelines have been split into two parts, which can be read below;

•  Prescribing medications to treat co-morbidities in rheumatic diseases during pregnancy and breastfeeding
•  Prescribing immunomodulatory drugs during pregnancy and breastfeeding, including biologics and small molecule drugs

 

Professor Ian Giles concluded “Pregnancy is one of the most important times in a person’s life, and those with rheumatic conditions have so much more to think about. Controlling disease during pregnancy is vital and most medications are safe to use. We hope these guidelines will support clinicians and give them the confidence to use medicines in pregnant patients.”

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Further reading:

• Lupus and pregnancy blog article
• Lupus: a guide to pregnancy