Rheumatologic drug use in pregnancy. ('A lot of gray areas').

CHICAGO--Many rheumatologic drugs carry risk during pregnancy, and decisions about which agents to use can be difficult, Dr. Rosalind Ramsey-Goldman said at a clinical symposium sponsored by the American College of Rheumatology.

"Although we wish we had a lot of evidence-based medicine to make our decisions, there are a lot of gray areas and a lot of judgment, and people value different things different ways," commented Dr. Ramsey-Goldman, professor of medicine at Northwestern University, Chicago.

Rheumatology has no A category drugs among the most widely used medications, she said.

Dr. Ramsey-Goldman made the following comments about some of the different drugs used in rheumatology:

* Glucocorticoids. Steroids are category B drugs. They do not impair fertility and large reporting databases have found no consistent fetal or infant problems that are associated with steroid use.

But prednisone crosses the placenta, and in rabbits and rodents very high doses of steroids have been consistently associated with cleft lip and palate. There is controversy about whether this occurs in humans, but the most cautious approach might be to avoid using steroids between the 8th and 11th weeks of gestation, when the palate is developing, she said.

* Sulfasalazine. In rats and rabbits given six times a normal human dose of this category B drug, there are no congenital anomalies or increased risks of miscarriage. Likewise, there is no evidence of miscarriage or fetal malformations in humans. However, there may be an increased risk of hyperbilirubinemia in preterm infants exposed prenatally in the third trimester.