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RheumNow Podcast - ACR Reproductive Health Slides (9-11-20)

d Jack Cush, MD

Dr. Jack Cush reviews the 2020 ACR Reproductive Health Guidelines presented all week here on RheumNow. 

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ACR 2020 Reproductive Guidelines - Lactation Guidance

d Jack Cush, MD

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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ICYMI - The Pregnancy & Lactation Labeling Rule Explained

d Jack Cush, MD

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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ACR 2020 Reproductive Guidelines - Medication Use with Pregnancy

d Jack Cush, MD

The American College of Rheumatology (ACR) has published guidelines to manage reproductive health issues in rheumatic disease (RMD) patients before, during and after pregnancy.

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ICYMI - 11 Pearls for Pregnancy Management in Rheumatoid Arthritis

d Artie Kavanaugh, MD,  , Jack Cush, MD

Rheumatoid arthritis affects women in their child-bearing years and many will face the issue of pregnancy and RA management at some point. Here are11 considerations for those managing RA patients who wish to become pregnant.



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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

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Dr. John Cush RheumNow ( View Tweet)
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

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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

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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

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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

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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.

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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

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Dr. John Cush RheumNow ( View Tweet)

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

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Dr. John Cush RheumNow ( View Tweet)

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

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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

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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

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Dr. John Cush RheumNow ( View Tweet)

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

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QD Videos from RheumNow Live. "I wanna get pregnant" (a controlled RA patient on tocilizumab) https://t.co/vfLgQPrl98

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Dr. John Cush RheumNow ( View Tweet)

Case series compared 247 pregnancies in IgA Vasculitis patients vs 556 control pregnancies showing IgA Vasculitis had no effect on fertility and did not induce flares. But IgAV had more spont. abortions, gestational HTN, preterm delivery. https://t.co/CCG2v6sMe1

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296 women with HTN during pregnancy (half/147 NSAID-exposed) - NSAID use was not associated with a significant change in BP (vs no NSAID) and there was no added need to start or increase BP meds in those on NSAIDS. https://t.co/g56xgQEPjr

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