Ankylosing Spondylitis

Selected References:

  • Bourg M, et al. 2020. Fertility and sexuality of women with inflammatory arthritis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 251:199-205. 
  • Giovannopoulou E, et al. 2017. Ankylosing Spondylitis and Pregnancy: A Literature Review. Curr Rheumatol Rev. 13(3):162-169. 
  • Girbash E, et al. 2023. Maternal Interleukin-17 and disease activity influence pregnancy outcomes in women with psoriatic arthritis. BMC Pregnancy Childbirth. 23(1):35. 
  • Gordon D, Beastall GH, Thomson JA, et al. 1986 Androgenic status and sexual function in males with rheumatoid arthritis and ankylosing spondylitis. Q J Med; 60(231): 671–679.  
  • Jakobsson GL, et al. 2016. Pregnancy outcomes in patients with ankylosing spondylitis: a nationwide register study. Ann Rheum Dis. 75(10):1838-42. 
  • Lee JS, et all. 2020. Reasons for the High Cesarean Delivery Rate among Women with Ankylosing Spondylitis: Using the Korean National Health Insurance Database. The Journal of Rheumatology, 47(5) 668-673. 
  • Lui NL, et al. 2011. Effect of pregnancy on ankylosing spondylitis: a case-control study. J Rheumatol 38(11):2442-4. 
  • Maguire S, et al. 2020. Pregnancy in axial spondyloarthropathy–A systematic review & meta-analysis. Semin Arthritis Rheum; 50(6):1269-1279. 
  • Maguire S, et al. 2022. What to expect when women with axial spondyloarthritis are expecting: Prevalence of complications of pregnancies in women with axial spondyloarthritis. Semin Arthritis Rheum; 54:151993. 
  • Menekse Beser D, et al. 2023. Assessment of fetal pulmonary artery Doppler indices in pregnant women with rheumatoid arthritis and ankylosing spondylitis. J Clin Ultrasound. 51(6):983-991. 
  • Mokbel A, et al. 2021. Pregnancy outcomes in women with ankylosing spondylitis: a scoping literature and methodological review. Clin Rheumatol; 40(9):3465-3480.   
  • Mørk S, et al. 2021. Spondyloarthritis and outcomes in pregnancy and labor–A nationwide register-based cohort study. Arthritis Care Res, 73(2), 282-288. 
  • Ostensen M. 1992. The effect of pregnancy on ankylosing spondylitis, psoriatic arthritis, and juvenile rheumatoid arthritis. Am J Reprod Immunol. 28(3-4):235-7. 
  • Ostensen M & Husby G. 1989. Ankylosing spondylitis and pregnancy. Rheum Dis Clin North Am.  15(2):241-54. 
  • Ostensen M & Ostensen H. 1998. Ankylosing spondylitis–the female aspect. J Rheumatol. 25(1):120-4. 
  • Ostensen M, et al. 2004. A prospective study of pregnant patients with rheumatoid arthritis and ankylosing spondylitis using validated clinical instruments. Ann Rheum Dis. 63(10):1212-7.   
  • Ramonda R, Foresta C, Ortolan A, et al. 2014. Influence of tumor necrosis factor α inhibitors on testicular function and semen in spondyloarthritis patients. Fertil Steril. 101(2): 359–365. 
  • Saougou I1, Markatseli TE, Papagoras C, et al. 2013. Fertility in male patients with seronegative spondyloarthropathies treated with infliximab. Joint Bone Spine; 80(1): 34–37. 
  • Scriffignano S, et al. 2024. Male Fertility in Spondyloarthritis: from Clinical Issues to Cytokines Milieu. A Narrative Review. Curr Rheumatol Rep. doi: 10.1007/s11926-024-01153-w.  
  • Smith CJF, et al. 2020. Birth Outcomes and Disease Activity During Pregnancy in a Prospective Cohort of Women With Psoriatic Arthritis and Ankylosing Spondylitis. Arthritis Care Res, 72:1029-1037. 
  • Unal C, et al. 2020. Retrospective evaluation of pregnancies with ankylosing spondylitis in a tertiary center in Turkey. Int J Rheum Dis. 23:101-105. 
  • Uyaroglu OA, Seyhoglu E, Erden A, et al. 2020. Pregnancy outcomes in partners of male ankylosing spondylitis patients treated with anti-tumour necrosis factor-α biologics: real-life results from a single-centre cross-sectional study. Rheumatol Int.;40(9):1501-1507.  
  • Yildirim M, et al. 2023. Assessment of fetal thymus size in pregnant women with rheumatic diseases: A case-control study. J Clin Ultrasound. 51(8): 1342-1347. 

 

Ankylosing Spondylitis

Selected References:

  • Deepaklal MC, et al. 2015. Insulin aspart in patients with gestational diabetes mellitus and pregestational diabetes mellitus. Indian J Endocrinol Metab; 19(5): 658–662. 
  • Hod M, et al. 2008. Fetal and perinatal outcomes in type 1 diabetes pregnancy: a randomized study comparing insulin aspart with human insulin in 322 subjects. Am J Obstet Gynecol’ 198(2)186.e1-7. 
  • Matheisen ER, et al. 2007. Maternal glycaemic control and hypoglycaemia in Type 1 diabetes pregnancy: a randomized trial of insulin aspart vs. human insulin in 322 pregnant women. Diabetes Care; 30(4):771-776. 
  • Mathiesen ER, et al. 2008. Insulin Aspart in Diabetic Pregnancy: State of the Art. Women’s Health 4(2):119-124.  
  • Mathiesen ER, et al; EVOLVE study group. 2024. A comparison of the safety and effectiveness of insulin aspart with other bolus insulins in women with pre-existing Type 1 diabetes during pregnancy: A post hoc analysis of a prospective cohort study. Diabet Med; 41(10):e15411.  
  • Insulin Aspart Product Label. 2023. National Institute of Health DailyMed database. Available at: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bee5b358-c863-420b-be73-ced2e920c499. Accessed 3/2026.  
  • Pettitt DJ, et al. 2007. Efficacy, safety and lack of immunogenicity of insulin aspart compared with regular human insulin for women with gestational diabetes mellitus. Diabet Med; 24(10): 1129–1135. 
  • Shehadeh N, et al. 2001. Importance of insulin content in infant diet: suggestion for a new infant formula. Acta Paediatr; 90(1):93-95. 
  • Shehadeh N, et al. 2001. Insulin in human milk and the prevention of type 1 diabetes. Pediatr Diabetes; 2(4):175-177. 
  • Whitmore TJ, et al. 2012. Analysis of Insulin in Human Breast Milk in Mothers with Type 1 and Type 2 Diabetes Mellitus. Int J Endocrinol. vol. 2012: Article ID 296368.  

Ankylosing Spondylitis

Selected References:  

  • Abdellatif M, et al. 2019. Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Eur J Pediatr. 178:301–314.  
  • Antonucci R, et al. 2022. Use of Azithromycin in Pregnancy: More Doubts than Certainties. Clinical drug invest. 42(11): 921–935.  
  • Bakheit, AH, et al. 2014. Azithromycin. Profiles of Drug Substn, Excip, and Rel Methodol. 39:1-40. 
  • Bérard A et al. 2015. Use of macrolides during pregnancy and the risk of birth defects: a population-based study. Pharmacoepidemiol Drug Saf 24(12):1241–1248. 
  • Cooper WO, et al. 2002. Prenatal prescription of macrolide antibiotics and infantile hypertrophic pyloric stenosis. Obstet Gynecol; 100:101–106.  
  • Cooper WO, et al. 2009. Antibiotics potentially used in response to bioterrorism and the risk of major congenital malformations. Paediatr Perinat Epidemiol. 23(1):18-28.  
  • Damkier P, et al. 2019. In utero exposure to antibiotics and risk of congenital malformations: a population-based study. Am J Obstet Gynecol 221(6):648.e1–648.e15. 
  • Fan H, et al. 2020. Associations between macrolide antibiotics prescribing during pregnancy and adverse child outcomes in the UKL Population based cohort study. BMJ 368:m331.  
  • Figueroa-Romero A, et al. 2022. Drugs for intermittent preventive treatment of malaria in pregnancy: current knowledge and way forward. Trop. Med. Infect. Dis. 8(7): 152. 
  • Goldstein LH, et al. 2009. The safety of macrolides during lactation. Breastfeed Med, 4(4):197-200.  
  • Heikkinen T., et al. 2005. The transplacental transfer of the macrolide antibiotics erythromycin, roxithromycin and azithromycin. BJOG: An Intern Jour of Obstet and Gynaecol. 107(6):770-775. 
  • Hume-Nixon M, et al. 2021. A systematic review and meta-analysis of the effect of administration of azithromycin during pregnancy on perinatal and neonatal outcomes. EClinicalMedicine 40:101123.  
  • Leke, AZ, et al. 2021. Macrolide and lincosamide antibiotic exposure in the first trimester of pregnancy and risk of congenital anomaly: A European case-control study. Reprod Toxicol 100:101–108. 
  • Lund M, et al. 2014. Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: nationwide cohort study. BMJ. 348:g1908.  
  • Mårdh PA. 2002. Influence of infection with chlamydia trachomatis on pregnancy outcome, infant health and life-long sequelae in infected offspring. Best Pract and Research Clin Obstet and Gynaec. 16(6): 847-864. 
  • Muanda FT, et al. 2017. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ. 189(17):625-633. 
  • Pfizer Labs. 2021. Zithromax (azithromycin) label. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/050670s036,050710s051,050711s050,050784s037lbl.pdf. Accessed 4 Nov 2025.  
  • Rahangdale L, et al. 2006. An observational cohort study of Chlamydia trachomatis treatment in pregnancy. Sex Transm Dis. 33(2):106-110. 
  • Sandman Z., Iqbal OA. 2024. Azithromycin. StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557766/. Accessed 4 Nov 2025.  
  • Sarkar M, et al. 2006. Pregnancy outcome following gestational exposure to azithromycin. BMC Pregnancy Childbirth. 6:18.  
  • Sørensen HT, et al. 2003. Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. Scand J Infect Dis. 35(2):104-106.  
  • Sutton A, et al. 2014. Azithromycin accumulates in breast milk following a single dose for cesarean prophylaxis. AJOG. 210(1):S235.  
  • Tellem R, et al. 2005. Pregnancy outcome after gestational exposure to the new macrolides: a prospective controlled cohort study. Reprod Toxicol.;20(3):484-485.  
  • U.S. Centers for Disease Control and prevention. 2021. Chlamydia Infections – STI Treatment Guidelines. Available at: https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm. Accessed 4 Nov 2025. 
  • Wilton LV, et al. 1998. The outcomes of pregnancy in women exposed to newly marketed drugs in general practice in England. Br J Obstet Gynaecol. 105(8): 882–889. 

Ankylosing Spondylitis

Selected References:

  • American Academy of Pediatrics Committee on Genetics. 2008. Maternal phenylketonuria. Pediatrics 122:445–449. 
  • American College of Obstetricians and Gynecologists Committee on Genetics. 2020. Management of women with phenylalanine hydroxylase deficiency (phenylketonuria). Obstet Gynec, 135(4):e167-e170.  
  • Bier C, et al. 2024. Outcomes in 14 live births resulting from Pegvaliase-treated pregnancies in PKU-affected females. Mol Genet Metab, 141(3):108152. 
  • BioMarin Pharmaceutical Inc. Palynziq medication label. Available at: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=6dba844a-db02-44f8-8593-ce497ed9406c&type=display. Accessed 27 October 2025.  
  • Cunningham A, et al. 2023. Nutrition management of PKU with pegvaliase therapy: Update of the web-based PKU nutrition management guideline recommendations. Orphanet J Rare Dis, 18:155. 
  • Fisch RO, et al. 1981 Semen studies on phenylketonurics. Biochem Med, 26(3):427434. Kopesky JJ, et al. 2024. Successful outcomes with continued pegvaliase-pqpz treatment throughout pregnancy and lactation in a PKU patient. Mol Genet Metab, 141:18. 
  • Levy HL, Waisbren SE. 1983. Effects of untreated maternal phenyketonura and hyperphenylalaninemia on the fetus. N Engl J Med, 309:1269-1274.  
  • Rohr F, et al. 2020. Discontinuation of pegvaliase therapy during maternal PKU pregnancy and postnatal breastfeeding: A case report. Mol Genet Metab Rep, 22:100555.  
  • Rohr F, et al. 2022. Reinstitution of pegvaliase therapy during lactation. Mol Genet Metab Rep, 33:100938.  
  • Teissier R, et al. 2012. Maternal phenylketonuria: low phenylalaninemia might increase the risk of intra uterine growth retardation. J Inherit Metab Dis, 35(6):993-999.  
  • U.S. Food and Drug Administration Center for Drug Evaluation and Research. Active Risk Identification and Assessment (ARIA) Sufficiency Memo for Pregnancy Safety Concerns. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/761079Orig1s000OtherR.pdf. Accessed 27 October 2025. 
  • Waisbren SE, et al. 2015. Maternal phenylketonuria: long-term outcomes in offspring and post-pregnancy maternal characteristics. JIMD Rep, 21:23-33. 

 

Ankylosing Spondylitis

Selected References:

  • Anderson KN, et al. 2020. ADHD medication use during pregnancy and risk for selected birth defects: National Birth Defects Prevention Study, 1998-2011. J Atten Dis. 24(3):479-489 
  • Bang Madsen K, et al. 2025. In utero exposure to methylphenidate, amphetamines and atomoxetine and offspring neurodevelopmental disorders – a population-based cohort study and meta-analysis. Molecular psychiatry, 30(9), 3885–3894. 
  • Benassayag Kaduri, N, et al. 2024. Amphetamine use for attention deficit hyperactive disorder during breastfeeding and children’s neurodevelopmental outcomes: A pilot study. Psychiatry research, 339, 116047.  
  • Cohen JM, et al. 2017. Placental complications associated with psychostimulant use in pregnancy. Obstet Gynecol. 130(6):1192-201.  
  • Eriksson M, et al. 1981. Amphetamine addiction and pregnancy II. Pregnancy, delivery, and the neonatal period. Socio-medical aspects. Acta Obstet Gynecol Scand 60:253-259.  
  • Food and Drug Administration. 2017. Adderall® CII. 2017. Accessed from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/011522s043lbl.pdf. 
  • Food and Drug Administration. 2013. Highlights of Prescribing Information – Adderall XR. Accessed from https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021303s026lbl.pdf.   
  • Garey JD, et al. 2020. Teratogen update: Amphetamines. Birth Defects Res. 112(15):1171-1182. 
  • Hasan SA, et al. 2026. Prescription Stimulant Continuation in Pregnancy and Birth Outcomes. Journal of attention disorders, 30(3), 315–328. 
  • Huybrechts KF, et al. 2018. Association Between Methylphenidate and Amphetamine Use in Pregnancy and Risk of Congenital Malformations: A Cohort Study From the International Pregnancy Safety Study Consortium. JAMA Psychiatry. 75(2):167-175. 
  • Ilett KF, et al. 2007. Transfer of dexamphetamine into breast milk during treatment for attention deficit hyperactivity disorder. Br J Clin Pharmacol, 63(3):371-375. 
  • Newport DJ, et al. 2016. Prenatal psychostimulant and antidepressant exposure and risk of hypertensive disorders of pregnancy. J Clin Psychiatry. 77(11):1538-45.  
  • Norby U, et al. 2017. Perinatal outcomes after treatment with ADHD medication during pregnancy. Pediatrics 140(6).  
  • Öhman I, et al. 2015. Narcolepsy treated with racemic amphetamine during pregnancy and breastfeeding. J Hum Lact 31:374-6. 
  • Pham MN, et al. 2022. The adverse association between stimulant use for attention deficit hyperactivity disorder (ADHD) and semen parameters. Andrologia, 54(2), e14315. 
  • Poulton AS, et al. 2018. Perinatal outcomes of women diagnosed with attention-deficit/hyperactivity disorder: An Australian population-based cohort study. CNS Drugs 32(4):377-386. 
  • Rose SJ, et al. 2020. Amphetamine-dextroamphetamine and pregnancy: neonatal outcomes after prenatal prescription mixed amphetamine exposure. J Attention Dis. 25(9): 1295-1301.
  • Russell DJ, et al. 2024. Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study. Archives of women’s mental health. 27(5), 785–94. 
  • Srinivas C, et al. 2025. Attention-Deficit/Hyperactivity Disorder Medication Use in Pregnancy and Risk of Preterm Birth: A Population-Based Cohort Study. Paediatric and perinatal epidemiology, 10.1111/ppe.70031. 
  • Steiner E et al. 1984. Amphetamine secretion in breast milk. Eur J Clin Pharmacol 27:123-4. 
  • Suarez EA, et al. 2024. Prescription Stimulant Use During Pregnancy and Risk of Neurodevelopmental Disorders in Children. JAMA psychiatry, 81(5), 477–488. 
  • Szpunar MJ, et al. 2023. Risk of Major Malformations in Infants After First-Trimester Exposure to Stimulants: Results From the Massachusetts General Hospital National Pregnancy Registry for Psychiatric Medications. Journal of clinical psychopharmacology, 43(4), 326–332. 
Ankylosing Spondylitis
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