A European League Against Rheumatism (EULAR) task force was established to define points to consider on use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Based on a systematic literature review and pregnancy exposure data from several registries, statements on the compatibility of antirheumatic drugs during pregnancy and lactation were developed. The level of agreement among experts in regard to statements and propositions of use in clinical practice was established by Delphi voting. The task force defined 4 overarching principles and 11 points to consider for use of antirheumatic drugs during pregnancy and lactation. Compatibility with pregnancy and lactation was found for antimalarials, sulfasalazine, azathioprine, ciclosporin, tacrolimus, colchicine, intravenous immunoglobulin and glucocorticoids. Methotrexate, mycophenolate mofetil and cyclophosphamide require discontinuation before conception due to proven teratogenicity. Insufficient documentation in regard to fetal safety implies the discontinuation of leflunomide, tofacitinib as well as abatacept, rituximab, belimumab, tocilizumab, ustekinumab and anakinra before a planned pregnancy. Among biologics tumour necrosis factor inhibitors are best studied and appear reasonably safe with first and second trimester use. Restrictions in use apply for the few proven teratogenic drugs and the large proportion of medications for which insufficient safety data for the fetus/child are available. Effective drug treatment of active inflammatory rheumatic disease is possible with reasonable safety for the fetus/child during pregnancy and lactation. The dissemination of the data to health professionals and patients as well as their implementation into clinical practice may help to improve the management of pregnant and lactating patients with rheumatic disease.

Autoimmune Diseases Research Unit Department of Internal Medicine Biocruces Health Research Institute University Hospital Cruces University of the Basque Country Bizkaia Spain

Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy Charité Universitätsmedizin Berlin Berlin Germany

Centre de Référence sur les Agents Tératogènes Groupe Hospitalier Universitaire Est Hôpital Armand Trousseau Paris France

Department of Clinical and Experimental Science Rheumatology and Clinical Immunology Unit Spedali Civili and University of Brescia Brescia Italy

Department of Mother and Child Hospital Luigi Sacco University of Milano Milano Italy

Department of Pediatrics University of California San Diego La Jolla USA

Department of Rheumatology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands

Department of Rheumatology Immunology and Allergology University Hospital of Bern Bern Switzerland

Department of Rheumatology University Hospital Coimbra Portugal

Department of Rheumatology University Hospital of Düsseldorf Duesseldorf Germany

Epidemiology Unit and Department for Rheumatology German Rheumatism Research Centre Charité University Medicine Berlin Germany

EULAR Social Leagues Patients' representative Leuven Belgium

EULAR Social Leagues Patients' representative Zürich Switzerland

Graham Hughes Lupus Research Laboratory Division of Women's Health King's College London The Rayne Institute St Thomas' Hospital London UK

Institute of Rheumatology Praha Czech Republic

National Service for Pregnancy and Rheumatic Diseases Department of Rheumatology Trondheim University Hospital Trondheim Norway Department of Neuroscience Norwegian University of Science and Technology Trondheim Norway

National Service for Pregnancy and Rheumatic Diseases Department of Rheumatology Trondheim University Hospital Trondheim Norway Department of Neuroscience Norwegian University of Science and Technology Trondheim Norway Department of Rheumatology Ålesund Hospital Ålesund Norway

Research Laboratories and Academic Division of Clinical Rheumatology Department of Internal Medicine University of Genova Genova Italy

Université Paris Descartes Paris France Service de médecine interne AP HP Hôpital Cochin Centre de référence maladies auto immunes et systémiques rares Paris France

Women's Health Academic Centre St Thomas' Hospital London UK

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