Rheumatic diseases are not exclusive to the elderly. Some rheumatic diseases love to attract young people, such as ankylosing spondylitis and systemic lupus erythematosus. Young people of childbearing age often ask: Can I stop taking the medication in order to get pregnant? How long should I stop? What medication should I take to prevent a relapse of the disease when I am already pregnant? These questions are often asked, so this time, based on the literature I found, I will post them here in a unified manner, hoping to be of some help to patients. Before proceeding with the following topic, let’s first introduce the FDA drug pregnancy risk classification, which is as follows: Class A: safe for use in patients during pregnancy (i.e., during pregnancy). In controlled drug studies, no evidence of fetal harm was seen in women in the first trimester (and no evidence of harm in the subsequent 6 months), and the effect of this class of drugs on the fetus was minimal. Category B: Use with caution when there are clear indications (indications refer to the scope and criteria for the appropriate use of drugs, surgery, etc.). No adverse effects of the drug on the fetus were seen in animal reproductive studies (controlled studies in pregnant women were not performed). Or the drug was found to have side effects in animal reproduction studies, but these side effects were not confirmed in a control group of women in the first trimester of pregnancy (and there was no evidence of harm in the subsequent 6 months). Category C: When there are indications for use (indications refer to the scope and criteria for the appropriate use of drugs, surgery, etc.), a full weighing of the pros and cons should be made. Animal studies have demonstrated that the drug is harmful to the fetus (teratogenic or fetal death, etc.), or there are no controlled studies in pregnant women, or there are no studies in pregnant women and animals. Use only after weighing the benefits to the pregnant woman against the harms to the fetus. Category D: Avoid, but use with caution under close observation when there is a definite indication for use (indication refers to the scope and criteria for the appropriate use of drugs, surgery, etc.) and the benefit to the patient outweighs the possible risks. There is clear evidence that the drug is harmful to the human fetus, but nevertheless, it is absolutely beneficial when administered to pregnant women (e.g., if the drug is used to save the life of a pregnant woman, or to treat a serious illness that has not been treated with other safer drugs). Class X: Prohibited. Drugs that have been studied in animals and humans or have been used in humans have been shown to be harmful to the fetus and are not beneficial to pregnant women, and are therefore contraindicated in pregnancy and in patients who may become pregnant. Rheumatic diseases are mostly chronic diseases, many of which are not completely curable at this time and need to be controlled by long-term medication. The following are some of the oral medications commonly used in the treatment of rheumatic diseases. Non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs (what are NSAIDs?) They are those such as mobicol, cilobal, fotarolim, etoricoxib, lexon, ibuprofen, naproxen, etc.) can pass through the placenta and are available in early pregnancy, in small doses, with a short half-life when used intermittently, when they belong to pregnancy category B (i.e. pregnancy). There is no increase in genetic malformations, and high or low doses of aspirin do not increase prenatal complications or neonatal mortality; however, they do increase the risk of miscarriage. Use NSAIDs with caution in mid- to late-pregnancy, when they are in category C. The use of NSAIDs in late pregnancy has been reported to cause premature occlusion of the fetal ductus arteriosus and consequently pulmonary hypertension; use in late pregnancy can also lead to congenital malformations during delivery (specifically during the period and process of fetal separation from the mother). The use of NSAIDs in late pregnancy can also lead to excessive bleeding during delivery (specifically, the period and process during which the fetus is separated from the mother and becomes an individual). NSAIDs are rarely excreted in breast milk, especially ibuprofen, and are recommended as the drug of choice during lactation because of their short half-life. They can be used during lactation in full-term healthy infants. NSAIDs can cause reversible infertility in women by delaying ovulation and preventing implantation of fertilized eggs, but no effects on male fertility have been reported. Glucocorticoids Glucocorticoids (there are many kinds of hormones, but the rheumatology department uses glucocorticoids with anti-inflammatory, anti-immune and anti-allergic effects, mainly prednisone, prednisolone, methylprednisolone (Medrol), dexamethasone, betamethasone and tretinoin) are widely used in the treatment of rheumatic diseases during pregnancy. Short-acting (short-acting means that the drug is present in the bloodstream for a short period of time and has a short duration of action after taking the drug) preparations such as prednisone (prednisone) belong to category B for pregnancy, but long-acting (long-acting after taking the drug and has a long duration of action) preparations such as dexamethasone and betamethasone belong to category C for pregnancy. When using them, it is necessary to specify whether the treatment is for a pregnant woman or a fetus. If the drug is intended for a pregnant woman, prednisone (prednisone) should be used. Prednisolone and methylprednisolone are recommended as short- and medium-acting agents, of which prednisone is recommended as the first choice because it enters the fetus through the placenta in the least amount. Glucocorticosteroids should be avoided in high doses in the month before conception and in the early stages of pregnancy. The application of glucocorticosteroids during pregnancy causes hypertension, diabetes, osteoporosis and infections in pregnant women, and should be applied with caution. Methotrexate Methotrexate can cause congenital malformations in the fetus mainly in the central nervous system (consisting of the brain and spinal cord (the brain and spinal cord are the central part of various reflex arcs and the most important part of the human nervous system), and is a class X pregnancy drug. It has been reported that the median time for complete clearance of the drug from the body is 4-10 weeks, so the drug should be discontinued for at least 3 months before pregnancy (i.e., pregnancy) before conception (3-6 months), and after discontinuation of the drug folic acid should be continued until the end of delivery (specifically, the period and process when the fetus is separated from the mother and becomes an independent individual)? Even though methotrexate may be excreted in low amounts through breast milk, it is not recommended for use during lactation. Cyclophosphamide Cyclophosphamide is a class D pregnancy (i.e., pregnancy) drug? Cyclophosphamide is absolutely contraindicated during early embryogenesis of pregnancy (i.e., pregnancy)? It can be used in the middle and late stages of pregnancy if it is necessary to save the patient’s life?Morris et al. reported that three patients diagnosed with breast cancer at 14-20 weeks of gestation (i.e., pregnancy) were given cyclophosphamide in combination with doxorubicin chemotherapy and that their three newborns were full-term, healthy, and free of congenital malformations. There is little information on the effects of cyclophosphamide use in male patients on their spouses’ pregnancies (i.e., pregnancy). Cyclophosphamide can cause irreversible ovarian failure in female patients, and the risk is related to the patient’s age, with a high risk in patients >31 years of age, and female patients with fertility requirements must be treated with concomitant fertility-protective drugs? Cyclophosphamide may also affect fertility in men. It is not known whether testicular function can be restored. Azathioprine Azathioprine (currently available under the trade name Imuran, etc.) can pass through the placenta and is a Class D drug for pregnancy, but the fetus lacks the enzyme that converts azathioprine to 6-mercaptopurine (inosinate pyrophosphorylase) in the liver and the maternally active 6-mercaptopurine cannot pass through the placenta. However, a number of studies have confirmed a correlation between azathioprine and intrauterine fetal growth retardation. When indicated for a medical condition, azathioprine should not be administered during pregnancy (i.e., gestation) in amounts greater than daily for infant safety during lactation, and studies have shown that breast milk has undetectable or low concentrations of the active ingredient 6-mercaptopurine. Sulfasalazine Lyuzoxapyridine is a class B gestational (i.e., pregnancy) drug with concentrations in cord blood comparable to those of the mother, but its use in small doses (2 g/day) during gestation (i.e., pregnancy) does not increase the risk of malformation, miscarriage, or preterm delivery, and does not increase fetal abnormalities. However, because it inhibits the synthesis of folic acid, there is an increased risk of neural tube defects, cleft lip, and cardiovascular defects, so adequate doses of folic acid are required throughout pregnancy (i.e., during pregnancy). However, at the time of delivery (specifically the period and process when the fetus separates from the mother and becomes an independent entity), the drug is classified as Class D by the FDA. The drug does not affect female fertility, but its metabolite sulfasalazine can cause reversible oligospermia and decreased sperm motility in men, who need to stop taking it for more than 3 months when considering fertility. Lactation with sulfasalazine has no significant effect on healthy full-term infants. For preterm infants and newborns who have developed xanthogranuloma, lactation is recommended 2 months after delivery (specifically, the period and process during which the fetus is separated from the mother and becomes an independent entity). Hydroxychloroquine Hydroxychloroquine (different manufacturers have different trade names for hydroxychloroquine, e.g., Seroquel, Streptavidin, etc.) is a class C drug for pregnancy. Hydroxychloroquine can enter the fetus through the placenta, and the cord blood concentration is comparable to that of the mother. However, current reports support the safety of using hydroxychloroquine during pregnancy (i.e., pregnancy), and the use of small doses of hydroxychloroquine against malaria during pregnancy has not increased congenital anomalies or abortion. The literature has reported no increase in genetic abnormalities and visual and auditory impairment with hydroxychloroquine during pregnancy in patients with SLE. Hydroxychloroquine is not only safe for the fetus, but also has good efficacy in the recurrence of disease during pregnancy (i.e., in SLE patients). Hydroxychloroquine is rarely excreted in breast milk and can be taken during lactation. There are no reports of effects of hydroxychloroquine on fertility in men and women. Leflunomide Leflunomide (different trade names from different manufacturers, same ingredients, such as Eroflav, Toloxil) has been shown in animal experiments to have significant teratogenic effects and is a class X pregnancy (i.e. pregnancy) drug. If pregnancy is planned, the drug should be discontinued with the administration of clofentezine (bilirubicin) to promote the excretion of leflunomide until the drug is undetectable in peripheral blood. The specific method is: 8g/day of cholecalciferol in three divided doses for 11 days (not consecutive), with an interval of at least two weeks for both measurements of less than 0.02ug/ml? Cyclosporine Cyclosporine A is a class C drug for pregnancy. Cyclosporine (2.5-5.0 mg/kg.d) can be used throughout pregnancy. Data from organ transplant patients indicate that cyclosporine A is safe for use during pregnancy (i.e., gestation), and there are several data showing that the incidence of preterm delivery and low birth weight infants with congenital fetal malformations in patients treated with cyclosporine A during pregnancy (i.e., gestation) is not significantly different from that of the general population. There is little information on the safety of cyclosporine A in infants when applied during lactation. Although there are reports of no significant adverse effects on the infant with the use of this drug during breastfeeding, it is not recommended for use during breastfeeding because the infant’s blood levels have reached therapeutic concentrations through breastfeeding. Thalidomide (i.e., Response Stop) Thalidomide (i.e., Response Stop) is an FDA-classified Class X drug and is contraindicated in pregnancy (i.e., gestation). The most dangerous period is 3-8 weeks of pregnancy, even if a single dose of 50 mg or 25 ml/day, 2-3 times/day. Morte-malcophenolate Morte-malcophenolate (also known as mycophenolate, different manufacturers produce products with different trade names, such as primaquine, Fu-Yi, etc.) is a class C pregnancy (i.e., pregnancy) drug. The typical malformations caused by this drug are known as EMFO tetralogy, namely Ear (ear hypertelorism and ear canal atresia) Mouth (cleft lip and constriction) Fingers (short fifth finger and hypoplastic nails) Organs ( Heart, kidney, central nervous system, septum and eye deformities). The U.S. Food and Drug Administration (FDA) specifically added a black box warning to its drug packaging to indicate its teratogenic effects. It has been reported that infants delivered to male patients’ spouses during the use of morte-macrolide (specifically, the period and process during which the fetus is separated from the mother and becomes an independent entity) are not associated with congenital malformations. Should the drug be discontinued for at least 6 weeks prior to conception? Azathioprine may be used as an alternative drug in patients with a pregnancy (i.e., pregnancy) plan. Motilmic acid esters are excreted in breast milk and are not recommended for use during lactation. Tacrolimus Tacrolimus (also known as FK506,) is a Class C pregnancy drug and there is no consensus on its safety during pregnancy (i.e., pregnancy)? Some expert groups recommend that if indicated (indication refers to the scope and criteria for the appropriate use of drugs, surgery, etc.), it can be applied at the lowest effective dose throughout pregnancy (i.e., pregnancy) and during lactation. I believe that the above introduction will be of some help to patients who are concerned about related topics.