Table 1.

Summary of drug compatibility in pregnancy and breastmilk exposure

	Peri-conception	First trimester	Second/third trimester	Breastfeeding	Paternal exposure
Corticosteroids
Prednisolone	Yes	Yes	Yes	Yes	Yes
Antimalarials
Hydroxychloroquine (≤400 mg/day)	Yes	Yes	Yes	Yes	Yes
Conventional synthetic DMARDs
Methotrexate (≤25 mg/week)	Stop ≥1 month pre-conception	No	No	No	Yes
Sulfasalazine (with folic acid 5 mg/day in first trimester)	Yes	Yes	Yes	Yesa	Yesb
Leflunomide	No: Cholestyramine washout	No	No	No	Yes
Azathioprine	Yes	Yes	Yes	Yes	Yes
Ciclosporin	Yes	Yesc	Yesc	Yes	Yes
Tacrolimus	Yes	Yesc	Yesc	Yes	Yes
Cyclophosphamide	Exceptional circumstancesd	Exceptional circumstancesd	Exceptional circumstancesd	No	No
Mycophenolate mofetil	Stop ≥6 weeks pre-conception	No	No	No	Yes
Intravenous immunoglobulin	Yes	Yes	Yes	Yes	Yes
Anti-TNFα medications
Infliximab	Yes	Yes	Yese	Yes	Yes
Etanercept	Yes	Yes	Yesf	Yes	Yes
Adalimumab	Yes	Yes	Yesg	Yes	Yes
Certolizumab	Yes	Yes	Yes	Yes	Yes
Golimumab	Yes	Yes	Yesg	Yes	Yes
Other biologic DMARDs
Rituximab	Consider stopping at conceptionh	Severe disease if no alternativesh	Severe disease if no alternativesi	Yesj	Yesj
IL-6 inhibitors	Consider stopping at conceptionh	Severe disease if no alternativesh	Severe disease if no alternativesi	Yesj	Yesj
IL-1 inhibitors	Consider stopping at conceptionh	Severe disease if no alternativesh	Severe disease if no alternativesi	Yesj	Yesj
Abatacept	Consider stopping at conceptionh	Severe disease if no alternativesh	Severe disease if no alternativesi	Yesj	Yesj
Belimumab	Consider stopping at conceptionh	Severe disease if no alternativesh	Severe disease if no alternativesi	Yesj	Yesj
IL-17 inhibitors	Consider stopping at conceptionh	Severe disease if no alternativesh	Severe disease if no alternativesi	Yesj	Yesj
IL-12/23 inhibitors	Consider stopping at conceptionh	Severe disease if no alternativesh	Severe disease if no alternativesi	Yesj	Yesj
Targeted synthetic DMARDs
JAK-inhibitors	Stop ≥2 weeks pre-conception	No	No	No	Yesj

For further information and caveats, see relevant recommendations and main text in the executive summary and full guideline.

^aIn the healthy, full-term infant only.

^bIf conception is delayed by >12months, consider stopping sulfasalazine alongside investigation of other causes of infertility.

^cSuggested monitoring of maternal blood pressure, renal function, blood glucose and drug levels.

^dOnly in cases of severe (life or organ-threatening) maternal disease.

^eIf low risk of disease flare and stopped by 20 weeks, full-term infant can have a normal vaccination schedule.

^fIf low risk of disease flare and stopped by 32 weeks, full-term infant can have a normal vaccination schedule.

^gIf low risk of disease flare and stopped by 28 weeks, full-term infant can have a normal vaccination schedule.

^hMay be considered to manage severe maternal disease if no other pregnancy-compatible drugs are suitable.

ⁱIf used in third trimester, avoid live vaccinations in infant vaccination schedule until 6 months of age.

^jLimited evidence.