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Dr Jack Cush reviews the news and journal reports from the past week on RheumNow.com:
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There has been little science or evidence regarding the effects of COVID-19 infection on pregnancy and vice versa; and now the recent MMWR addresses the subject with two new reports
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Dr. Jack Cush reviews the 2020 ACR Reproductive Health Guidelines presented all week here on RheumNow.
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In this third excerpt from the ACR guidelines on managing reproductive health issues in rheumatic disease patients, we present recommendations regarding the use of glucocorticoids and guidance on lactation and medication use post-partum.
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A recent article from Healio.com reviewed the FDA’s Pregnancy and Lactation Labeling Rule (PLLR) that became effective June 30th.
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The American College of Rheumatology (ACR) has published guidelines to manage reproductive health issues in rheumatic disease (RMD) patients before, during and after pregnancy.
NM Rheumatology
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How pregnancy impacts nr-axSpA disease activity can vary from one woman to another, according to Eric Ruderman, MD, “I’ve had some patients who are better during pregnancy, and some who aren’t,” says Dr. Ruderman. Learn more about pregnancy and nr-axSpA:
https://t.co/mC6YcG5lIx
Dr. John Cush
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RheumNow Podcast - ACR Reproductive Health Slides (9-11-20)
Dr Jack Cush reviews the 2020 ACR Reproductive Health Guidelines
This past week we presented an overview to the new 2020 ACR
ACR 2020 Reproductive Guidelines - Contraception & Counseling
https://t.co/vnPh2EQZ0a https://t.co/T4y69DYIH7
Dr. John Cush
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Candian study of 376 pregnancies (284 F) with #SLE and drug use: only 24.2% on antimalarials, 8.2% azathioprine, 19.7% steroids & 4.8% on NSAIDs during pregnancy. 1st trimester discontinuations seen in 16.7% of HCQ & 29.2% AZA https://t.co/a1SMwZuSlm
Dr. John Cush
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Swedish registry comparison of 541 PsA 40944 non-PsA pregnancies between 1997-2014, shows PsA pregnancies had increased risks for preterm birth (adj OR 1.63) and caesarean deliveries (OR 1.47), but no increased risks for pre-eclampsia, stillbirth https://t.co/3Udpjhn1pe
Dr. John Cush
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Discontinuing TNFi before wk 20 is feasible in RA and JIA pregnancy with well- controlled Dz. OTIS study of 490 women compared 25% who D/C TNFi before wk 20 vs 41% taking TNFi after wk 20. D/C TNF not assoc w/ clinical worsening in the 3rd trimester. https://t.co/DtHvQ2rbWY
Dr. John Cush
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New data on tocilizumab in pregnancy, upshot is: "Tocilizumab concentrations in cord blood and infant serum were 80–90% of those in maternal serum" https://t.co/SEmyTnL7dy
Dr. John Cush
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Immunomonitoring with microarrays from the SLE PROMISE pregnancy study shows that adverse outcomes (preeclampsia) can be identified by quantifying plasma cell, interferon and neutrophil RNA levels during the pregnancy https://t.co/oLOwkiGhQ2.
Dr. John Cush
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117 pregnancies exposed to biologics were compared to 585 pregnancies not exposed to biologics; 6% of newborns had ≥1 congenital anomalies. No significant association between biologic exposure and congenital anomalies (HR 1.06; 95%CI 0.46-2.47) was seen. https://t.co/gsKHGiFPOS
Dr. John Cush
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Systematic review of Paternal DMARD exposure prior to pregnancy shows no firm evidence of harm with TNFi, ABA, RTX, azathioprine, cyclosporine, HCQ, leflunomide, MTX or mycophenolate mofetil. Data from 84 papers, 611 male exposures, 5986 pregnancies https://t.co/VgEsrXhfdh
Dr. John Cush
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The PARA study shows among 249 pregnancies (2002-08), breastfeading was less in RA - at 4-6, 12 & 26 wks postpartum 43%, 26% and 9% of the RA breastfed (vs 63%, 46% &; 41% in controls). Many patients D/C breastfeeding so they could start medication. https://t.co/2205YnoHsb https://t.co/mMyLgMNFfM
Dr. John Cush
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Small study of 25 pregnancies in RA compared those who continued biologics till conception vs those who stopped before conception. Continuing biologics till conception lead to a significantly shorter time to pregnancy. https://t.co/x9EptzkvYr
Dr. John Cush
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Dr Uma Mahadevan and colleagues have published guidelines for managing pregnancy in IBD patients. Rec coordinated care w/ maternal-fetal medicine subspecialist, GI doc, preconception planning, more on treatement https://t.co/oAFcGlOU2y
Dr. John Cush
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Free full read review "Postnatal Care of Woman with Rheumatic Dz". 46% of RA pts will flare postpartum; breast feeding is ok w/ most biologics; Hold Live vaccines if Pt is on a biologic during pregnancy; VTE prophylaxis essential for 10 d–6 wks postpartum. https://t.co/Ol23S0GiEW
Dr. John Cush
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QD Videos from RheumNow Live. "I wanna get pregnant" (a controlled RA patient on tocilizumab) https://t.co/vfLgQPrl98
