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Vol. 6. Issue 1.
Pages 43-48 (January - February 2010)
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Vol. 6. Issue 1.
Pages 43-48 (January - February 2010)
DOI: 10.1016/S2173-5743(10)70008-3
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Drugs employed during pregnancy and contraceptive methods in rheumatic disease. New evidence
Fármacos durante el embarazo y métodos contraceptivos en enfermedades reumáticas. Nuevas aportaciones
Xavier Juanola Roura
Corresponding author
, Valeria Ríos Rodríguez, Diana de la Fuente de Dios
Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
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Voluntary birth control, the ability to identify the best moment for becoming pregnant depending on disease activity, and the need to avoid conception during the administration of teratogenic drugs are the main reasons for the use of contraceptive methods among women with rheumatic diseases.

This article reviews the risks that antirheumatic drugs represent during conception, pregnancy and lactation and the contraceptive methods that are currently available to patients. Hormonal therapy has developed considerably and can further our understanding of safety aspects, especially for systemic lupus erythematosus patients. Recently the methods of administration have evolved, and now include transdermal and intravaginal routes, a progesterone-releasing intrauterine device, and an extended-cycle oral contraceptive.

Rheumatologists work increasingly in conjunction with patients to assist in choices regarding contraceptive methods and pregnancy planning. Each decision should be individualized according to the personal preference and the stage of reproductive life.


El control voluntario de la natalidad, el hecho de poder establecer el mejor momento de la gestación en función de la actividad de la enfermedad y la necesidad de evitar el embarazo debido a la indicación de fármacos potencialmente teratógenos constituyen las razones principales para la utilización de métodos contraceptivos en pacientes afectas de enfermedades reumáticas.

En este artículo se revisan los posibles riesgos durante el embarazo de las medicaciones utilizadas en reumatología y los diversos métodos contraceptivos disponibles actualmente. En los últimos años se ha producido un mejor conocimiento de la seguridad de los métodos contraceptivos hormonales con datos especialmente relevantes de su utilización en pacientes con lupus eritematoso sistémico. La evolución de la contracepción hormonal con nuevas vías de administración, como la transdérmica, la intravaginal y los dispositivos intrauterinos o los implantes liberadores de progestágenos, han significado avances evidentes en este campo.

La implicación del reumatólogo, como responsable de la atención de estos pacientes, es requerida con mayor frecuencia y el conocimiento de todos los métodos disponibles, con todas sus ventajas, desventajas y efectos adversos ayudará a facilitar información para que la pareja pueda escoger en cada caso la mejor opción.

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K. Temprano, R. Bandlamudi, T.L. Moore.
Antirheumatic drugs in pregnancy and lactation.
Semin Arthritis Rheum, 35 (2005), pp. 112-121
N.M. Jansen, M.S. Genta.
The effects of Immunosupressive and anti-inflammatory medications on fertility, pregnancy and lactation.
Arch Inten Med, 160 (2000), pp. 610
J.A. Martínez-López.
Revisión sistemática: ¿es seguro el uso de AINE durante el embarazo en mujeres con afección sistémica?.
Reum Clin, 4 (2008), pp. 191-196
C.N. Pisoni, D.P. D’Cruz.
The safety of mycophenolate mofetil in pregnancy.
Expert Opin Drug Saf, 7 (2008), pp. 219-222
M. Ostensen, M. Lockshin, A. Doria, G. Valesini, P. Meroni, C. Gordon, et al.
Update on safety during pregnancy of biological agents and some immunosuppressive antirheumatic drugs.
Rheumatology, 47 (2008), pp. iii28-iii31
Y. Snoeckx, G. Keenan, M. Sanders, M. Gardiner.
Pregnancy in women taking Infliximab: The Infliximab Safety Database.
Arthritis Rheum, (2008),
D.L. Johnson, K.L. Jones, C. Chambers.
Pregnancy outcomes in women exposed to Etanercept: The OTIS Autoimmunity Diseases in Pregnancy Project.
Arthritis Rheum, (2008),
D.L. Johnson, K.L. Jones, C. Chambers.
Pregnancy outcomes in women exposed to adalimumab: the OTIS Autoimmunity Diseases in Pregnancy Project.
Arthritis Rheum, (2008),
E.Y. King, K.D. Watson, D.P.M. Symmons, K.L. Hyrich.
Pregnancy outcome in women exposed to anti-TNF agents: An update from the British Society for Rheumatology Biologics Register (BSRBR).
Arthritis Rheum, (2008),
M. Ojeda-Uribe, C. Gilliot, G. Jung, B. Drenou, A. Brunot.
Administration of rituximab during the first trimester of pregnancy without consequences for the newborn.
J Perinatol, 26 (2006), pp. 252-255
World Health Organization (2005). Criterios médicos de elegibilidad para el uso de anticonceptivos Tercera edición-2005. ( 10/12/2008).
R. Erkkola.
Recent advances in hormonal contraception.
Current Opinion in Obstetrics & Gynecology, 19 (2007), pp. 547-553
A.M. Kaunitz.
Beyond the pill: new data and options in hormonal and intrauterine contraception.
Am J Obstet Gynecol, 192 (2005), pp. 998-1004
R. Burkman, J. Schlesselman, M. Zieman.
Safety concerns and health benefits associated with oral contraception.
Am J Obstet Gynecol, 190 (2004), pp. 5-22
Collaborative Group on Hormonal Factors in Breast Cancer.
Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies.
Lancet, 347 (1996), pp. 1713-1727
I. Martinelli.
Risk factors in venous thromboembolism.
Thromb Haemost, 86 (2001), pp. 395-403
J.M. Kemmeren, B.C. Tanis, M. van den Bosch, E. Bollen, F.M. Helmerhorst, Y. Van der Graaf, et al.
Risk of Arterial Thrombosis in Relation to Oral Contraceptives (RATIO) study: oral contraceptives and the risk of ischemic stroke.
Stroke, 33 (2002), pp. 1202-1208
D.B. Pettiti, S. Sidney, A. Bernstein, S. Wolf, C.H. Quesenberry, H.K. Ziel, et al.
Stroke in users of low dose contraceptives.
N Engl J Med, 335 (1996), pp. 8-15
M. Petri, C. Robinson.
Oral contraceptives and systemic lupus eruthematosus.
Arthriris Rheum, 40 (1997), pp. 797-803
J. Sanchez-Guerrero, E.W. Karlson, M.H. Liang, D.J. Hunter, F.E. Speizer, G.A. Colditz.
Past use of oral contraceptives and the risk of developing systemic lupus erythematosus.
G.S. Cooper, M.A. Dooley, E.L. Treadwell, E.W. St Clair, G.S. Gilkeson.
Hormonal and reproductive risk factors for development of systemic lupus erythematosus: results of a population based, case-control study.
Arthritis Rheum, 46 (2002), pp. 1830-1839
A.A. Bengtsson, L. Rylander, L. Hagmar, O. Nived, G. Sturfelt.
Risk factors for developing systemic lupus erythematosus: a case-control study in southern Sweden.
Rheumatology, 41 (2002), pp. 563-571
M.O. Bernier, Y. Mikaeloff, M. Hudson, S. Suissa.
Combined oral contraceptive Use and the risk of systemic lupus erythematosus.
Arthritis Rheum, 61 (2009), pp. 476-481
P. Jungers, M. Dougados, C. Pelissier, F. Kuttenn, F. Tron, P. Lesavre, J.F. Bach.
Influence of oral contraceptive therapy on the activity of systemic lupus erythematosus.
Arthritis Rheum, 25 (1982), pp. 618-623
H.A. Julkunen.
Oral contraceptives in systemic lupus erythematosus side-effects and influence on the activity of SLE.
Scand J Rheum, 20 (1991), pp. 427-433
J.P. Buyon, M.A. Petri, M.Y. Kim, K.C. Kalunian, J. Grossman, B.H. Hahn, et al.
The effect of combined estrogen and progesterone hormone replacement therapy on disease activity in systemic lupus erythematosus: a randomized trial.
Ann Intern Med, 142 (2005), pp. 953-962
M. Petri, M.Y. Kim, K.C. Kalunian, J. Grossman, B.H. Hahn, L.R. Sammaritano, et al.
Combined oral contraceptives in women with systemic lupus erythematosus.
N Engl J Med, 353 (2005), pp. 2550-2558
J. Sánchez-Guerrero, A.G. Uribe, L. Jiménez-Santana, M. Mestanza-Peralta, P. Lara-Reyes, A.H. Seuc, et al.
A trial of contraceptive methods in women with systemic lupus erythematosus.
N Engl J Med, 353 (2005), pp. 2539-2549
Z.E. Schaedel, G. Dolan, M.C. Powell.
The use of the levonorgestrel-releasing intrauterine system in the management of menorrhagia in women with hemostatic disorders.
Am J Obstet Gynecol, 193 (2005), pp. 1361-1363
P.S. Wells, J. Hirsh, D.R. Anderson, A.W. Lensing, G. Foster, C. Kearon, et al.
Accuracy of clinical assessment of deep-vein thrombosis.
Lancet, 345 (1995), pp. 1326-1330
J.A. Otubu, O.A. Towobola, A.O. Aisien, O.O. Ogunkeye.
Effects of Norplant contraceptive subdermal implants on serum lipids and lipoproteins.
Contraception, 47 (1993), pp. 149-159
World Health Organization Colaboratives Study of Cardiovascular Disease and Steroid Hormone Contraception: Venous thromboembolic disease end combined oral contraceptive: results of an International multicentric case–control study.
Lancet, 346 (1995), pp. 1575-1582
W.O. Spitzer, M.A. Lewis, L.A. Heinemann, M. Thorogood, K.D. MacRae.
Third generation oral contraceptives and risk of venous thromboembolic disorders: an international case-control study.
BMJ, 312 (1996), pp. 83-88
S.S. Jick, J.A. Kaye, S. Russmann, H. Jick.
Risk of nonfatal venous thromboembolism with oral contraceptives containing norgestimate or desogestrel compared with oral contraceptives containing levonorgestrel.
Contraception, 73 (2006), pp. 566-570
R. Lisa.
Sammaritano Therapy Insight: guidelines for selection of contraception in women with rheumatic diseases.
Nat Clin Pract Rheumatol, 3 (2007), pp. 273-281
C.S. Vieira, R.A. Ferriani, A.A. Garcia, M.C. Pinta, G.D. Azevedo, M.K.O. Gomes, et al.
Use of the etonogestrel-releasing implant is associated with hypoactivation of the coagulation cascade.
Human Reproduction, 22 (2007), pp. 2196-2201
M. Shaarawy, S.Y. El-Mallah, S. Seoudi, M. Hassan, I.A. Mohsen.
Effects of the longterm use of depot medroxyprogesterone acetate as hormonal contraceptive on bone mineral density and biochemical markers of bone remodelling.
Contraception, 74 (2006), pp. 297-302
R. Forastiero, M. Martinuzzo, Y. Adamczuk, M.L. Varela, G. Pombo, L.O. Carreras.
The combination of thrombophilic genotypes is associated with definite antiphospholipid syndrome.
Haematologica, 86 (2001), pp. 735-741
J.L. Brouwer, M. Bijl, N. Veeger, H. Kluin-Nelemans, J. Van der Meer.
The contribution of inherited and acquired thrombophilic defects, alone or combined with antiphospholipid antibodies, to venous and arterial thromboembolism in patients with systemic lupus erythematosus.
Blood, 104 (2004), pp. 143-148
C. Jorgensen, M.C. Picot, C. Bologna, J. Sany.
Oral contraception, parity, breast feeding, and severity of rheumatoid arthritis.
Ann Rheum Dis, 55 (1996), pp. 94-98
M. Pikwer, U. Bergström, J.A. Nilsson, L. Jacobsson, G. Berglund, C. Turesson.
Breastfeeding, but not oral contraceptives, is associated with a reduced risk of rheumatoid arthritis.
Ann Rheum Dis, (2008),
S.S. Bhatia, D.S. Majka, J.M. Kittelson, L.A. Parrish, E.D. Ferucci, K.D. Deane, et al.
Rheumatoid factor seropositivity is inversely associated with oral contraceptive use in women without rheumatoid arthritis.
Ann Rheum Dis, 66 (2007), pp. 267-269
K.W. Drossaers-Bakker, A.H. Zwinderman, D. van Zeben, F.C. Breedveld, J.M.W. Hazes.
Pregnancy and oral contraceptive use do not significantly influence outcome in long term rheumatoid arthritis.
Ann Rheum Dis, 61 (2002), pp. 405-408
J. Lekakis, M. Mavrikakis, C. Papamichael, S. Papazoglou, O. Economou, I. Scotiniotis, et al.
Short-term estrogen administration improves abnormal endothelial function in women with systemic sclerosis and Raynaud's phenomenon.
Am Heart J, 136 (1998), pp. 905-912
M.L. Bartelink, H. Wollersheim, H. Vemer, C.M. Thomas, T. de Boo, T. Thien.
The effects of single oral doses of 17 beta-oestradiol and progesterone on finger skin circulation in healthy women and in women with primary Raynaud's phenomenon.
Eur J Clin Pharmacol, 46 (1994), pp. 557-560
Copyright © 2010. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
Reumatología Clínica (English Edition)

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