title: Treatment with biologics of pregnant patients with rheumatic diseases.
abstract: OBJECTIVE
  Due to limited human pregnancy experience safety issues in regard to children exposed antenatally to biological drugs are still under debate. A survey of new published experience on biological agents during pregnancy is necessary to assist clinicians with adequate counseling and management of patients who desire children.
  
  
  RESULTS
  No controlled study has been published on use of TNFα inhibitors, rituximab, abatacept, tocilizumab or anakinra in pregnancy during the years 2009-2010. New case reports confirm that all monoclonal antibodies expose the child to the full adult dose when administered in late pregnancy with a risk for adverse effects in the newborn and perinatally. Data from a drug registry show that preconceptional and early first-trimester use of rituximab appears to confer no serious side effect to the child. Case reports on abatacept, tocilizumab or anakinra in pregnancy are not conclusive.
  
  
  CONCLUSIONS
  Differences in molecular structure of TNFα inhibitors may turn out to favor the use of agents that are not complete monoclonal antibodies in women who consider pregnancy. The very limited experience with abatacept, tocilizumab or anakinra in pregnancy allows no statement as to their compatibility with pregnancy. At present use of biological agents throughout pregnancy cannot be recommended.
authors.affiliation: Pregnancy Research Unit, Department of Rheumatology, Clinical Immunology and Allergology, University Hospital and University of Berne, Berne, Switzerland. monika.ostensen@gmail.com
authors.forename: Monika
authors.initials: M
authors.lastname: Ostensen
authors.forename: Frauke
authors.initials: F
authors.lastname: Förger
mesh_terms: D000069594:Abatacept; D000328:Adult; D000818:Animals; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000493:pharmacokinetics; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D001688:Biological Products / Q000009:adverse effects* / Q000493:pharmacokinetics; D002648:Child; D005260:Female; D006801:Humans; D018796:Immunoconjugates / Q000009:adverse effects; D053590:Interleukin 1 Receptor Antagonist Protein / Q000009:adverse effects; D008297:Male; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011248:Pregnancy Complications / Q000378:metabolism / Q000628:therapy*; D012216:Rheumatic Diseases / Q000150:complications* / Q000378:metabolism / Q000628:therapy*; D000069283:Rituximab; D013091:Spermatogenesis / Q000187:drug effects; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D001688:Biological Products; D018796:Immunoconjugates; D053590:Interleukin 1 Receptor Antagonist Protein; D014409:Tumor Necrosis Factor-alpha; D000069283:Rituximab; D000069594:Abatacept; C502936:tocilizumab