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22 - Biological and Immunosuppressive Respiratory Therapy in Pregnancy

from Section 5 - Other Pulmonary Issues in Pregnancy

Published online by Cambridge University Press:  14 April 2020

By
Bernadette Jenner  and
Catherine Nelson-Piercy
Edited by
Stephen E. Lapinsky  and
Lauren A. Plante
Stephen E. Lapinsky
Affiliation:
Mount Sinai Hospital, Toronto
Lauren A. Plante
Affiliation:
Drexel University Hospital, Philadelphia
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Summary

Before prescribing in pregnancy it is important to understand the potential pharmacodynamic and pharmacokinetic changes of medications related to physiological changes in pregnancy, e.g. increased plasma volume, increased renal excretion, and also the bioavailability of the medication to the mother, fetus and infant through breastfeeding.

Type
Chapter
Information
Respiratory Disease in Pregnancy , pp. 200 - 209
Publisher: Cambridge University Press
Print publication year: 2020

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References

Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gyenaecologists, UK medical eligibility criteria for contraceptive use 2016. 2016. www.fsrh.org/standards-and-guidance/documents/ukmec-2016/ (accessed November 2019).Google Scholar
Thorsson, L, Borga, O, Edsbacker, S. Systemic availability of budesonide after nasal administration of three different formulations: pressurized aerosol, aqueous pump spray, and powder. Br J Clin Pharmacol. 1999 47(6):619–24.CrossRefGoogle ScholarPubMed
Derendorf, H, Nave, R, Drollmann, A, Cerasoli, F, Wurst, W. Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma. Eur Respir J. 2006 28(5): 1042–50.Google Scholar
Szefler, SJ. Pharmacokinetics of intranasal corticosteroids. J Allergy Clin Immunol. 2001 108(1 Suppl):S26–31.Google Scholar
Corren, J. Intranasal corticosteroids for allergic rhinitis: how do different agents compare? J Allergy Clin Immunol. 1999 104(4 Pt 1): S144–9.CrossRefGoogle ScholarPubMed
Norjavaara, E, de Verdier, MG. Normal pregnancy outcomes in a population-based study including 2,968 pregnant women exposed to budesonide. J Allergy Clin Immunol. 2003 111(4):736–42.Google Scholar
Kallen, B, Rydhstroem, H, Aberg, A. Congenital malformations after the use of inhaled budesonide in early pregnancy. Obstet Gynecol. 1999 93(3): 392–5.Google ScholarPubMed
Kallen, BA, Otterblad Olausson, P. Maternal drug use in early pregnancy and infant cardiovascular defect. Reprod Toxicol. 2003 17(3):255–61.Google Scholar
Ellegard, EK, Hellgren, M, Karlsson, NG. Fluticasone propionate aqueous nasal spray in pregnancy rhinitis. Clin Otolaryngol Allied Sci. 2001 26(5):394–400.CrossRefGoogle ScholarPubMed
Berard, A, Sheehy, O, Kurzinger, ML, Juhaeri, J. Intranasal triamcinolone use during pregnancy and the risk of adverse pregnancy outcomes. J Allergy Clin Immunol. 2016 138(1):97–104.Google Scholar
Gilbert, C, Mazzotta, P, Loebstein, R, Koren, G. Fetal safety of drugs used in the treatment of allergic rhinitis: a critical review. Drug Saf. 2005 28(8): 707–19.Google Scholar
Yawn, B, Knudtson, M. Treating asthma and comorbid allergic rhinitis in pregnancy. J Am Board Fam Med. 2007 20(3):289–98.Google Scholar
Namazy, J, Schatz, M, Long, L, et al. Use of inhaled steroids by pregnant asthmatic women does not reduce intrauterine growth. J Allergy Clin Immunol. 2004 113(3):427–32.CrossRefGoogle Scholar
Rahimi, R, Nikfar, S, Abdollahi, M. Meta-analysis finds use of inhaled corticosteroids during pregnancy safe: a systematic meta-analysis review. Hum Exp Toxicol. 2006 25(8):447–52.Google Scholar
Falt, A, Bengtsson, T, Kennedy, BM, et al. Exposure of infants to budesonide through breast milk of asthmatic mothers. J Allergy Clin Immunol. 2007 120(4):798–802.Google Scholar
Carmichael, SL, Shaw, GM. Maternal corticosteroid use and risk of selected congenital anomalies. Am J Med Genet. 1999 86(3):242–4.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Pradat, P, Robert-Gnansia, E, Di Tanna, GL, et al. First trimester exposure to corticosteroids and oral clefts. Birth Defects Res A Clin Mol Teratol. 2003 67(12):968–70.Google Scholar
Carmichael, SL, Shaw, GM, Ma, C, et al. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol. 2007 197(6):585, e1–7; discussion 683–4, e1–7.Google Scholar
Hviid, A, Molgaard-Nielsen, D. Corticosteroid use during pregnancy and risk of orofacial clefts. Can Med Assoc J. 2011 183(7):796–804.Google Scholar
Skuladottir, H, Wilcox, AJ, Ma, C, et al. Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014 100(6):499–506.Google Scholar
Bay Bjørn, AM, Ehrenstein, V, Hundborg, HH, et al, Use of corticosteroids in early pregnancy is not associated with risk of oral clefts and other congenital malformations in offspring. Am J Ther. 2014 21(2):73–80.Google Scholar
Gotestam Skorpen, C, Hoeltzenbein, M, Tincani, A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016 75(5):795–810.Google Scholar
British Thoracic Society/Scottish Intercollegiate Guidelines Network. BTS/SIGN Asthma Guideline. 2016. www.brit-thoracic.org.uk/document-library/guidelines/asthma/btssign-asthma-guideline-2016/ (accessed November 2019).Google Scholar
Bracken, MB, Triche, EW, Belanger, K, et al. Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies. Obstet Gynecol. 2003 102(4):739–52.Google ScholarPubMed
Romejko-Wolniewicz, E, Oleszczuk, L, Zaręba-Szczudlik, J, Czajkowski, K. Dosage regimen of antenatal steroids prior to preterm delivery and effects on maternal and neonatal outcomes. J Matern Fetal Neonatal Med. 2013 26(3):237–41.CrossRefGoogle ScholarPubMed
Murphy, VE, Namazy, JA, Powell, H, et al. A meta-analysis of adverse perinatal outcomes in women with asthma. Br J Obstet Gynaecol. 2011 118(11):1314–23.Google Scholar
Fisher, JE, Smith, RS, Lagrandeur, R, Lorenz, RP. Gestational diabetes mellitus in women receiving beta-adrenergics and corticosteroids for threatened preterm delivery. Obstet Gynecol. 1997 90(6):880–3.Google Scholar
Kim, C. Gestational diabetes: risks, management, and treatment options. Int J Womens Health. 2010 2:339–51.Google Scholar
Schatz, M, Dombrowski, MP, Wise, R, et al. The relationship of asthma medication use to perinatal outcomes. J Allergy Clin Immunol 2004 113(6):1040–5.Google Scholar
Ost, L, Wettrell, G, Björkhem, I, Rane, A. Prednisolone excretion in human milk. J Pediatr. 1985 106(6):1008–11.CrossRefGoogle ScholarPubMed
Jain, A, Venkataramanan, R, Lever, J, et al. FK506 and pregnancy in liver transplant patients. Transplantation. 1993 56(6):1588–9.Google Scholar
Calne, RY, Brons, IG, Williams, PF, et al. Successful pregnancy after paratopic segmental pancreas and kidney transplantation. Br Med J (Clin Res Ed). 1988 296(6638):1709.Google Scholar
Suzuki, T, Ishii-Watabe, A, Tada, M, et al. Importance of neonatal FcR in regulating the serum half-life of therapeutic proteins containing the Fc domain of human IgG1: a comparative study of the affinity of monoclonal antibodies and Fc-fusion proteins to human neonatal FcR. J Immunol 2010 184(4):1968–76.CrossRefGoogle ScholarPubMed
Mahadevan, U, Wolf, DC, Dubinsky, M, et al. Placental transfer of anti-tumor necrosis factor agents in pregnant patients with inflammatory bowel disease. Clin Gastroenterol Hepatol, 2013. 11(3): p. 286–92; quiz e24.CrossRefGoogle ScholarPubMed
Mahadevan, U., Cucchiara, S, Hyams, JS, et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn’s and Colitis Organisation: pregnancy and pediatrics. Am J Gastroenterol. 2011 106(2): 214–23.Google Scholar
Gisbert, JP, Chaparro, M. Safety of anti-TNF agents during pregnancy and breastfeeding in women with inflammatory bowel disease. Am J Gastroenterol. 2013 108(9):1426–38.Google Scholar
Cheent, K, Nolan, J, Shariq, S, et al. Case report: fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn’s disease. J Crohns Colitis. 2010 4(5):603–5.Google Scholar
Murashima, A, Watanabe, N, Ozawa, N, Saito, H, Yamaguchi, K. Etanercept during pregnancy and lactation in a patient with rheumatoid arthritis: drug levels in maternal serum, cord blood, breast milk and the infant’s serum. Ann Rheum Dis. 2009 68(11):1793–4.Google Scholar
Kane, S, Ford, J, Cohen, R, Wagner, C. Absence of infliximab in infants and breast milk from nursing mothers receiving therapy for Crohn’s disease before and after delivery. J Clin Gastroenterol. 2009 43(7):613–16.Google Scholar
Stengel, JZ, Arnold, HL. Is infliximab safe to use while breastfeeding? World J Gastroenterol. 2008 14(19):3085–7.Google Scholar
Ben-Horin, S, Yavzori, M, Katz, L, et al. Adalimumab level in breast milk of a nursing mother. Clin Gastroenterol Hepatol. 2010 8(5):475–6.Google Scholar
Moretti, ME, Verjee, Z, Ito, S, Koren, G. Breast-feeding during maternal use of azathioprine. Ann Pharmacother. 2006 40(12):2269–72.CrossRefGoogle ScholarPubMed
Sau, A, Clarke, S, Bass, J, et al. Azathioprine and breastfeeding: is it safe? Br J Obstet Gynaecol. 2007 114(4):498–501.CrossRefGoogle ScholarPubMed
Flint, J, Panchal, S, Hurrell, A, et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: analgesics and other drugs used in rheumatology practice. Rheumatology (Oxford). 2016 55(9):1698–702.Google Scholar
Perez-Aytes, A, Marin-Reina, P, Boso, V, et al. Mycophenolate mofetil embryopathy: A newly recognized teratogenic syndrome. Eur J Med Genet. 2017 60(1):16–21.Google Scholar
Brent, RL. Teratogen update: reproductive risks of leflunomide (Arava): a pyrimidine synthesis inhibitor: counseling women taking leflunomide before or during pregnancy and men taking leflunomide who are contemplating fathering a child. Teratology. 2001 63(2):106–12.Google Scholar
Keidel, SM, Hoyles, RK, Wilkinson, NM. Efficacy of tocilizumab for interstitial lung disease in an undifferentiated autoinflammatory disorder partially responsive to anakinra. Rheumatology (Oxford). 2014 53(3):573–4.Google Scholar
Mohr, M, Jacobi, AM. Interstitial lung disease in rheumatoid arthritis: response to IL-6 R blockade. Scand J Rheumatol. 2011 40(5):400–1.Google Scholar
Buescher, ES, Malinowska, I. Soluble receptors and cytokine antagonists in human milk. Pediatr Res. 1996 40(6):839–44.Google Scholar
Borro, JM, De la Torre, M, Míguelez, C, et al. Comparative study of basiliximab treatment in lung transplantation. Transplant Proc. 2005 37(9):3996–8.Google Scholar
Christie, JD, Edwards, LB, Kucheryavaya, AY, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report – 2012. J Heart Lung Transplant. 2012 31(10):1073–86.Google Scholar
Danesi, R, Del Tacca, M. Teratogenesis and immunosuppressive treatment. Transplant Proc. 2004 36(3):705–7.Google Scholar
Novartis. Pharmaceuticals Product Information: Simulect. 2005. www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/simulect.pdf (accessed November 2019).Google Scholar
Ortega, HG, Liu, MC, Pavord, ID, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014 371(13):1198–207.Google Scholar
GlaxoSmithKline. Product Information. Nucala. 2015. www.accessdata.fda.gov/drugsatfda_docs/label/2015/125526Orig1s000Lbl.pdf (accessed November 2019).Google Scholar
Furie, R, Petri, M, Zamani, O, et al. A phase III, randomized, placebo-controlled study of belimumab, a monoclonal antibody that inhibits B lymphocyte stimulator, in patients with systemic lupus erythematosus. Arthritis Rheum. 2011 63(12):3918–30.Google Scholar
Navarra, SV, Guzmán, RM, Gallacher, AE, et al. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011 377(9767):721–31.Google Scholar
Gordon, JK, Martyanov, V, Franks, JM, et al. Belimumab for the treatment of early diffuse systemic sclerosis: results of a randomized, double-blind, placebo-controlled, pilot trial. Arthritis Rheumatol. 2017 70(2):308–16.Google Scholar
Hinduja Global Solutions. Product Information. Benlysta. 2015. www.accessdata.fda.gov/drugsatfda_docs/label/2012/125370s016lbl.pdf (accessed November 2019).Google Scholar
Gridelli, C, Maione, P, Rossi, A, De Marinis, F. The role of bevacizumab in the treatment of non-small cell lung cancer: current indications and future developments. Oncologist. 2007 12(10):1183–93.Google Scholar
Mohr, M, Schliemann, C, Biermann, C, et al. Rapid response to systemic bevacizumab therapy in recurrent respiratory papillomatosis. Oncol Lett. 2014 8(5):1912–18.Google Scholar
Genentech. Product information. Avastin. 2007. www.accessdata.fda.gov/drugsatfda_docs/label/2009/125085s0169lbl.pdf (accessed November 2019).Google Scholar
Cross, SN, Ratner, E, Rutherford, TJ, Schwartz, PE, Norwitz, ER. Bevacizumab-mediated interference with VEGF signaling is sufficient to induce a preeclampsia-like syndrome in nonpregnant women. Rev Obstet Gynecol. 2012 5:2–8.Google ScholarPubMed
Polizzi, S, Mahajan, VB. Intravitreal Anti-VEGF Injections in Pregnancy: Case Series and Review of Literature. J Ocul Pharmacol Ther. 2015 31(10):605–10.Google Scholar
Genentech. Product Information, Xolair. 2005. www.accessdata.fda.gov/drugsatfda_docs/label/2016/103976s5225lbl.pdf (accessed November 2019).Google Scholar
Namazy, J, Cabana, MD, Scheuerle, AE, et al. The Xolair Pregnancy Registry (EXPECT): the safety of omalizumab use during pregnancy. J Allergy Clin Immunol. 2015 135(2):407–12.Google Scholar
Sperber, K, Hom, C, Chao, CP, Shapiro, D, Ash, J. Systematic review of hydroxychloroquine use in pregnant patients with autoimmune diseases. Pediatr Rheumatol Online J. 2009 7:9.Google Scholar
Costedoat-Chalumeau, N, Amoura, Z, Duhaut, P, et al. Safety of hydroxychloroquine in pregnant patients with connective tissue diseases: a study of one hundred thirty-three cases compared with a control group. Arthritis Rheum. 2003 48(11):3207–11.Google Scholar
Diav-Citrin, O, Blyakhman, S, Shechtman, S, Ornoy, A. Pregnancy outcome following in utero exposure to hydroxychloroquine: a prospective comparative observational study. Reprod Toxicol. 2013 39:58–62.Google Scholar
Izmirly, PM, Costedoat-Chalumeau, N, Pisoni, CN, et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation. 2012 126(1):76–82.CrossRefGoogle ScholarPubMed
Ostensen, M, Brown, ND, Chiang, PK, Aarbakke, J. Hydroxychloroquine in human breast milk. Eur J Clin Pharmacol. 1985 28(3):357.Google Scholar
Clowse, ME, Feldman, SR, Isaacs, JD, et al. Pregnancy outcomes in the tofacitinib safety databases for rheumatoid arthritis and psoriasis. Drug Saf. 2016 39(8):755–62.Google Scholar
Soh, MC, Nelson-Piercy, C. High-risk pregnancy and the rheumatologist. Rheumatology (Oxford). 2015 54(4):572–87.CrossRefGoogle ScholarPubMed
Weber-Schoendorfer, C, Chambers, C, Wacker, E, et al. Pregnancy outcome after methotrexate treatment for rheumatic disease prior to or during early pregnancy. A prospective multicenter cohort study. Arthritis Rheumatol. 2014 66(5):1101–10.Google Scholar
Sanofi-Aventis. Product Information, Taxotere. 2008. www.accessdata.fda.gov/drugsatfda_docs/label/2010/020449s059lbl.pdf (accessed November 2019).Google Scholar
Kim, JH, Kim, HS, Sung, CW, et al. Docetaxel, gemcitabine, and cisplatin administered for non-small cell lung cancer during the first and second trimester of an unrecognized pregnancy. Lung Cancer 2008 59(2):270–3.Google Scholar
Nieto, Y, Santisteban, M, Aramendía, JM, et al. Docetaxel administered during pregnancy for inflammatory breast carcinoma. Clin Breast Cancer. 2006 6(6):533–4.Google Scholar
Rouzi, AA, Sahly, NN, Sahly, NF, Alahwal, MS. Cisplatinum and docetaxel for ovarian cancer in pregnancy. Arch Gynecol Obstet. 2009 280(5):823–5.Google Scholar
Clowse, ME, Magder, L, Petri, M. Cyclophosphamide for lupus during pregnancy. Lupus. 2005 14(8):593–7.Google Scholar
McGrath, SE, Ring, A. Chemotherapy for breast cancer in pregnancy: evidence and guidance for oncologists. Ther Adv Med Oncol. 2011 3(2):73–83.CrossRefGoogle ScholarPubMed
Amant, F, Loibl, S, Neven, P, Van Calsteren, K. Breast cancer in pregnancy. Lancet. 2012 379(9815):570–9.Google Scholar
Nelson-Piercy, C, Agarwal, S, Lams, B. Lesson of the month: selective use of cyclophosphamide in pregnancy for severe autoimmune respiratory disease. Thorax 2016 71(7): 667–8.Google Scholar
Wiernik, PH, Duncan, JH. Cyclophosphamide in human milk. Lancet. 1971 1(7705):912.Google Scholar

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