Polynucleotides in Pregnancy and Breastfeeding

General Principles

The European League Against Rheumatism recommends that treatment decisions must weigh maternal benefit against fetal risk, with the understanding that untreated maternal disease carries its own significant risks for adverse pregnancy outcomes 1.
The American College of Rheumatology suggests that disease control should be optimized before conception using pregnancy-compatible medications, as stable quiescent disease is a prerequisite for improved outcomes in both mother and child 1.
Planned pregnancies are essential to avoid exposure to potentially teratogenic drugs during critical periods of organogenesis, particularly the first trimester, according to the European League Against Rheumatism 1.
The first trimester represents the highest risk period for medication-induced congenital malformations, as this is when organogenesis occurs, as stated by the American Academy of Pediatrics 2.

The World Health Organization recommends that breastfeeding provides substantial health benefits and is recommended as the best source of nutrition for infants, with exclusive breastfeeding recommended for approximately 6 months 3, 4, 1.
The American Academy of Pediatrics suggests that women should not be discouraged from breastfeeding while taking compatible medications, as the benefits of breastfeeding for both infant and mother are well-established 1.
The European League Against Rheumatism states that infant drug exposure through breast milk depends on multiple variables including drug concentration in breast milk, quantity ingested, and absorption through the infant's gastrointestinal tract 3, 4.
The American Academy of Pediatrics notes that premature infants require additional consideration as they may have different pharmacokinetic profiles 3, 4.

If treatment cannot be deferred, consider the molecular characteristics: small molecules are more likely to cross the placenta than large molecules, according to the American College of Rheumatology 3.
Avoid use during first trimester if possible unless maternal disease severity clearly outweighs theoretical fetal risks, as recommended by the European League Against Rheumatism 1.
Implement close maternal and fetal monitoring if treatment is deemed necessary, as suggested by the American Society of Hematology 5, 6.
Monitor the infant for any adverse effects if maternal treatment continues during breastfeeding, according to the American Academy of Pediatrics 7.

Assuming all medications have equivalent safety profiles during pregnancy and lactation is incorrect; each agent requires individual assessment, as stated by the American Academy of Pediatrics 2.
Failing to provide preconception counseling to women of childbearing age about medication compatibility with pregnancy, as recommended by the European League Against Rheumatism 1.