Pregnancy safety and disease prevention are essential for women with rheumatic disease.

Compared to the general population, pregnant women with active rheumatic disease are more likely to experience negative outcomes, such as hypertension, preeclampsia, a higher caesarean section rate, small-for-gestational-age new-borns, premature delivery, and foetal loss. Rheumatic disease should be under control before conception with treatments that are safe to use during pregnancy in order to reduce the risk of these problems.

These are a few of the conclusions made in a recent review study published in Rheumatic Disease Clinics of North America by medical professionals from UT Southwestern.

"Women of reproductive age frequently suffer from rheumatic diseases. Rheumatologists must be aware of how to treat pregnant women with rheumatic disorders, according to Bonnie Bermas, M.D., professor of internal medicine at the UT Southwestern Division of Rheumatic Diseases. We will be able to assist patients in achieving their family planning objectives if we have a better grasp of how to manage pregnancies in our patients.

The dangers of pregnancy for women with rheumatic disease and the safety of drugs during pregnancy and breastfeeding were discussed by Dr. Bermas and colleagues in the article. The three illnesses — rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and obstetric antiphospholipid syndrome — were the focus of the review (APS).

Each entails various risks and factors:

·       Pregnancy results in disease remission in almost half of RA patients. On the other hand, some RA sufferers go through flares. RA flare-ups during pregnancy are linked to active disease prior to conception and stopping RA medication, whereas low disease activity prior to conception is linked to disease control.

·       For many years, SLE patients were frequently advised to postpone getting pregnant due to worries about the disease's activity escalating and having unfavourable effects. Women with very active disease, particularly those with significant renal disease, continue to have poor pregnancy outcomes. It can be difficult to distinguish between preeclampsia and an SLE flare while managing renal flare during pregnancy. However, many SLE patients who maintain minimal disease activity can have healthy pregnancies. Importantly, maintaining treatment with hydroxychloroquine, a cornerstone drug, enhances pregnancy results.

·       Three first-trimester pregnancy losses, a second or third-trimester loss, an early delivery at less than 34 weeks, or severe preeclampsia in women with antiphospholipid antibodies are all considered signs of obstetric APS. During pregnancy, these people need to take anticoagulants and low-dose aspirin.

In the end, the greatest route to a healthy pregnancy is to have the disease under good control while using medications that are safe for pregnancy. Many antirheumatic medications can be used during pregnancy, however, some cannot.

Because pregnant women are typically not included in clinical studies, Dr. Bermas stated that we know very little about the safety of drugs during pregnancy. Guidelines on the use of drugs during pregnancy and breastfeeding in cases of the rheumatic disease have been published as a result of efforts over the past few years. It should be noted that low-dose aspirin, immunosuppressive drugs including azathioprine, cyclosporine, tacrolimus, and hydroxychloroquine are all safe to take throughout pregnancy and breastfeeding. An essential component of reproductive rheumatology care is pre-conception counselling with a rheumatologist with expertise in this field or a maternal-fatal medicine specialist.