Date: June 2022, Version 3.0.1

Quick read

Rituximab can be used in pregnancy to treat inflammatory illnesses. Babies who were exposed in later pregnancy might be offered some of their vaccinations at a later time than usual.

What is it?

Rituximab (MabThera®; Rixathon®; Ruxience®; Truxima®) is an antibody therapy for some inflammatory illnesses, including rheumatoid arthritis, granulomatosis with polyangiitis, and microscopic polyangiitis. It is also used to treat certain types of lymphoma and leukaemia.


What are the benefits of using rituximab in pregnancy?

Because rituximab reduces a type of white blood cell in the immune system, it is an effective treatment for some blood cancers.

Through this effect on white blood cells, rituximab can also stop the immune system from attacking the body’s tissues in some inflammatory illnesses. This is important to reduce unpleasant symptoms and prevent long-term damage. It may also lower the chance of some pregnancy problems linked to uncontrolled inflammation, including miscarriage and lower infant birth weight.


What are the risks of using rituximab in pregnancy?

Use of rituximab in pregnancy has been studied in only a small number of women. There is no suggestion that rituximab affects the baby’s development but ongoing data collection is ideally required to confirm this.

Rituximab used in later pregnancy might affect the baby’s immune system for several months after birth. Live vaccines should be avoided during this time. This means that the baby cannot be vaccinated against rotavirus (as this needs to be completed by four months) and is unlikely to be offered the BCG vaccine (if required) until they are at least six months old. A doctor will be able to advise about the best time for the baby to be given any live vaccinations.


Are there any alternatives to using rituximab in pregnancy?

Possibly, depending on the severity of the illness it is being used for.

Women receiving rituximab as part of cancer chemotherapy should be reviewed by their oncologist. In some cases it may be safe to stop treatment for a while. Other women may be advised to continue on the drug to ensure their condition remains well-controlled and to prevent pregnancy complications linked to the underlying illness.

Women using rituximab to treat an inflammatory condition might be advised to continue or may be switched to another medicine. Some women may find that their symptoms improve during pregnancy; if so, their specialist may advise that their medicine(s) can be altered or stopped. However, women should not change or stop their medication without speaking to their doctor.
Women using rituximab who are planning a pregnancy should speak to their GP or specialist to determine which medicine is best.
If a woman has an unplanned pregnancy while taking rituximab she should be reviewed by her doctor as soon as possible.

No treatment

What if I prefer not to take medicines during pregnancy?

It is important that blood cancers and inflammatory conditions are well-treated during pregnancy, in order to avoid a flare-up of symptoms and to reduce the chance of certain pregnancy complications. A doctor will be happy to discuss any concerns.

Will I or my baby need extra monitoring?

As part of routine antenatal care in the UK, women are invited for a very detailed scan at around 20 weeks of pregnancy to check the baby’s development. No further scans to check for birth defects will be required, although extra growth scans may be offered. Women with the conditions that rituximab is used to treat will usually be offered closer monitoring during pregnancy.

Are there any risks to my baby if the father has used rituximab?

There is currently no evidence that rituximab used by the father can harm the baby through effects on the sperm.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.


How can I help to improve drug safety information for pregnant women in the future?

Our online reporting system (MyBump Portal) allows women who are currently pregnant to create a secure record of their pregnancy, collected through a series of questionnaires. You will be asked to enter information about your health, whether or not you take any medicines, your pregnancy outcome and your child's development. You can update your details at any time during pregnancy or afterwards. This information will help us better understand how medicines affect the health of pregnant women and their babies. Please visit the MyBump Portal to register.

General information
Sadly, miscarriage and birth defects can occur in any pregnancy.

Miscarriage occurs in about 1 in every 5 pregnancies, and 1 in every 40 babies are born with a birth defect. This is called the ‘background risk’ and happens whether medication is taken or not.

Most medicines cross the placenta and reach the baby. For many medications this is not a problem. However, some medicines can affect a baby’s growth and development.

If you take regular medication and are planning to conceive, you should discuss whether your medicine is safe to continue with your doctor/health care team before becoming pregnant. If you have an unplanned pregnancy while taking a medicine, you should tell your doctor as soon as possible.

If a new medicine is suggested for you during pregnancy, please make sure that the person prescribing it knows that you are pregnant. If you have any concerns about a medicine, you can check with your doctor, midwife or pharmacist.

Our Bumps information leaflets provide information about the effects of medicines in pregnancy so that you can decide, together with your healthcare provider, what is best for you and your baby.