Since the liberalization of the national policy on second child, the number of patients consulting about pregnancy preparation and pregnancy in rheumatology and lupus clinics has been increasing, especially about the medications for rheumatologic diseases during pregnancy preparation, pregnancy and lactation, which is a hot topic of concern. So, today, Dr. Yu will discuss with you the rheumatic immune disease medication preparation, pregnancy and lactation with the latest guidelines and past literature, combined with clinical experience. (1) Prednisone can be used during pregnancy preparation, pregnancy and lactation, but it is recommended that the maintenance dose should not exceed 15mg per day during pregnancy preparation and lactation, and if the dose of prednisone during lactation exceeds 20mg per day (i.e. more than 4 tablets), it is recommended to take the drug for 4 hours before lactation. Prednisone is safe for use in the whole period of preparation, pregnancy and breastfeeding, with a high level of evidence in the guidelines and a high recommendation level, and it deserves to be the first on the list. (2) methylprednisolone and prednisolone (it should be noted that here is prednisolone, different from prednisone) in the latest guidelines recommended in lactation, pregnancy and the father can use, but in view of methylprednisolone and prednisolone still has a certain rate of placental transfer, Dr. Yu recommended the use of prednisone in pregnancy or preferred. 2. Hydroxychloroquine Hydroxychloroquine is also a very safe drug and can be used during pregnancy preparation, throughout pregnancy, and during lactation. Furthermore, studies have shown that the use of hydroxychloroquine in patients with SLE can reduce the recurrence of the disease during pregnancy, reduce the occurrence of abnormal pregnancies, reduce the risk of thrombosis in patients with anticardiolipin antibody syndrome, reduce the occurrence of co-infections, and reduce lipid metabolism disorders. It is recommended for patients with anti-SSA/SSB positivity to reduce the incidence of fetal heart block. Based on all of the above, hydroxychloroquine is also at the top of the list of medications for pregnancy preparation, pregnancy and lactation, and, more importantly, in the treatment of SLE. The recommended dose is 200 mg twice a day, and no reduction in dose is recommended. 3.Lyuzosulfapyridine Lyuzosulfapyridine can be used during pregnancy, but it is recommended to supplement with folic acid tablets 5mg daily at the same time; lactation can use Lyuzosulfapyridine; Lyuzosulfapyridine can reduce male fertility, but there is no recommendation to stop using Lyuzosulfapyridine for pregnancy preparation, unless the preparation for pregnancy is unsuccessful for more than 1 year, otherwise the impact of Lyuzosulfapyridine is not examined. 4. Azathioprine: Azathioprine ≤2mg/Kg.D can be used during pregnancy; the application of azathioprine during lactation is not contraindicated; it can be used for male pregnancy preparation. 5.Cyclosporine (CsA) and Tacrolimus Both of these drugs can be used in the lowest effective dose during pregnancy; they can be used during lactation; they can also be used for male pregnancy preparation. 6.Intravenous gammaglobulin can be used during pregnancy and lactation and is considered harmless to the organism. Mycophenolate is contraindicated during pregnancy; discontinued at least 6 weeks prior to pregnancy preparation; not recommended during lactation as it can be secreted through breast milk. Limited evidence suggests that it can be used for male pregnancy preparation, but it is not routinely recommended. 8. Methotrexate (MTX), leflunomide (LEF), cyclophosphamide The above three drugs are not recommended for use during pregnancy preparation, pregnancy and lactation. Methotrexate should be discontinued 3 months prior to pregnancy preparation. Patients using Leflunomide need to be eluted with abciximide before pregnancy preparation. 9. Thalidomide is prohibited for use during pregnancy, gestation and lactation. (Special emphasis here 10. Biological agents (1) anti-tumor necrosis factor inhibitors: infliximab (class g) can be used until 16 weeks of pregnancy, while etanercept (Enzyme) and adalimumab (Xumel) can be used until mid-pregnancy; the above drugs can be used during lactation, but caution is recommended; limited evidence recommends that the above drugs can be used during male pregnancy preparation. (2) Tolimumab (Yamiro): should be discontinued more than 3 months in advance of pregnancy preparation; however, accidental use in early pregnancy may not be harmful; not recommended during lactation; may not be harmful during male pregnancy preparation, but the recommendation level is low. (3) Rituximab (Merova) should be discontinued 6 months before pregnancy; accidental use in early pregnancy may be harmless; not recommended during lactation; may be harmless during male pregnancy preparation, again, the recommendation level is lower. 11, NSAIDs use in the first 3 months of pregnancy, there is an increased risk of fetal malformation, after 20 weeks of pregnancy can lead to fetal renal insufficiency, so early pregnancy should also be cautious; use after 32 weeks of pregnancy can occur premature closure of the fetal ductus arteriosus, the risk increases up to 15 times, therefore, must be avoided; the above data are mainly non-selective NSAIDs, for COX-2 inhibitors without much research, pregnancy It is best to avoid the use; most NSAID breast milk content during lactation is very little, and no clear adverse reactions were found with the drug during lactation. 12. Aspirin For patients with diseases such as anticardiolipin antibody syndrome requiring aspirin, small doses of <325 mg per day during pregnancy can be used throughout pregnancy.