BSR issue guidelines on medicating during pregnancy and breastfeeding25 November 2022The British Society for Rheumatology (BSR) has produced two new guidelines for the prescribing of medication for patients who are pregnant or breastfeeding.Naturally, taking any medication during pregnancy can be risky and is a great worry to patients, but the risks of this need to be weighed against the importance of keeping RA under good control, not least so that the mother is strong and healthy to be able to look after her baby once they are born. We know that around three quarters of women experience a temporary remission during pregnancy, but that still leaves around 25% with uncontrolled RA. We also know that those who experience this period of remission sadly often experience a big flare up shortly after giving birth. This can of course then have implications for breastfeeding, if there is a risk of the medication passing into breast milk.For obvious ethical reasons, studies are not performed on pregnant women, so the information we have develops over time, firstly from any animal testing done when the drug was first produced and then through women who continued their medication during pregnancy (sometimes due to not knowing they were pregnant).The two new guidelines cover:Prescribing medications to treat co-morbidities in rheumatic diseases during pregnancy and breastfeeding. Prescribing immunomodulatory drugs during pregnancy and breastfeeding, including biologics and small molecule drugs.These update the previous guidelines from 2016 and they can be viewed here.