Table 4.

Recommendations for the use of medications for pregnancy planning.

Medication	Recommendation for pregnancy planning	Indication during pregnancy	FDA 1979 class	Comment for using during pregnancy	Maternal adverse reactions	Fetal/neonatal adverse reactions	Lactation
Aspirin (low dose)	Start before conception	Obstetric APS	B/C	80–100 mg/d used isolated or in combination with LMWH	Bleeding	No	Allowed
Azathioprine	Without stopping	Used in cases requiring immunosuppression and to save corticoid	D∗	1–2,5 mg/Kg/d	Liver toxicity and bone marrow toxicity	No	Allowed
Belimumab	Not start during pregnancy Not stop during pregnancy	Arthritis, other inflammatory	C	10 mg/kg IV q2 weeks ×3 doses, Maintenance: 10 mg/kg IV q4 weeks	Reactivation of tuberculosis	No	Not allowed
Cyclosporine A			C	Blood pressure monitor	Increase of blood pressure	Low birth weight	Not allowed
Cyclophosphamide	Stop > 6 months before conception	Not allowed	X				Not allowed
Fluorinated corticosteroids	It will be used in more advanced pregnancy	NLE and maturity of fetal lungs	B	Use betamethasone 12 mg/d for two days	Uncontrolled glycemic	No	Allowed
Hydroxychloroquine	Keep the drug to prevent reactivation of lupus	Lupus, arthritis	N	200–400 mg/d	Maternal skin hyperpigmentation	No	Allowed
Leflunomide	Stop 3–6 months before conception	Not allowed	X				Not allowed
Low-molecular weight heparin	Generally used	Obstetric APS	C	Used in prophylactic dose of 0.5 mg/Kg QID for OBAPS and in full dose 1 mg/Kg BID for thrombotic APS	Osteoporosis, thrombocytopenia	No	Allowed
NSAID	Avoid since it may decrease	Arthritis, other inflammatory	C/D	Avoid in the 3rd trimester	Gastric bleeding	Premature closure of the ductus arteriosus, oligohydramnios	Allowed
Methotrexate	Stop 3–6 months before conception	Not allowed	X				Not allowed
Mycophenolate mofetil	Stop before conception	Not allowed	X				Not allowed
Prednisone/prednisolone	Try to minimize dose due to maternal AEs	Lupus, arthritis, other inflammatory diseases	C	Inactivated in the placenta, minimize dose due to maternal AEs	Increase of blood pressure, osteopenia, gestational diabetes, immunosuppression, grooves.	Cleft lip sporadically Low birth weight Premature birth	Allowed (if more than 40 mg, wait for 3 hours)
Rituximab	Not start during pregnancy Not stop during pregnancy	Arthritis, other inflammatory	C	375 mg/m²/IV q4 weeks	Reactivation of tuberculosis	No	Not allowed
Statins	Stop before conception	Not allowed	X				Not Allowed
ACEi	Stop before conception	Not allowed	D			Fetal death, renal dysfunction and oligohydramnios	Allowed
Tacrolimus		Used in cases requiring immunosuppression	C	0,1–0,2 mg/kg/d	Diabetes, increase of blood pressure, reactivation of tuberculosis	Increase of blood pressure, diarrhea, headache, renal dysfunction	Not allowed
Warfarin	Stop at conception	Not allowed	X				Allowed

AEs: adverse events; APS: antiphospholipid syndrome; OBAPS: obstetric APS; ACEi: angiotensin converting enzyme inhibitor.