Pregnancy and Rheumatic Diseases

M. Gayed; C. Gordon

Disclosures

Rheumatology. 2007;46(11):1634-1640. 

In This Article

Abstract and Introduction

Abstract

Pregnancy is an issue that should be discussed with all patients with rheumatic diseases who are in the reproductive age group. Infertility is rarely due to the disease but can be associated with cyclophosphamide therapy. Most rheumatic diseases that are well controlled prior to pregnancy do not deteriorate in pregnancy, providing that the patient continues with appropriate disease-modifying therapy. Some patients with inflammatory arthritis go in to remission during pregnancy. Patients with renal involvement may be at increased risk of disease flare. This needs to be distinguished from pre-eclampsia. Intrauterine growth restriction is more likely in patients with active systemic disease, hypertension, a history of thrombosis and renal involvement. Premature delivery may need to be planned to reduce the risks of stillbirth and can be associated with a variety of neonatal complications. Post-partum flare is common in all the rheumatic diseases.

Introduction

In the past, women with rheumatic diseases were advised against pregnancy due to maternal and fetal morbidity and mortality and the complex influence of sex hormones on immunity. Recently, however, it has been found that with good disease control and rigorous monitoring, there is no reason why the majority of these women should not have the opportunity to bear children.

This review aims to discuss the maternal and fetal effects of pregnancy in systemic lupus erythematosus (SLE), Sjögren's syndrome, anti-phospholipid syndrome (APS), rheumatoid arthritis (RA), spondylarthropathies, the vasculitides and systemic sclerosis. The review will be divided into four sections. The first will be the effect of rheumatic diseases in the mother on fertility, followed by the effects of pregnancy on the disease, then the risk of transmission of disease from mother to foetus, and finally fetal outcome in the different rheumatic diseases. Therapy for these diseases during pregnancy will not be discussed but the reader is recommended to read an excellent review by Ostensen et al.[1] It should be noted that there is a paucity of controlled studies addressing the prevalence of the complications discussed, and that most of the observations are from cohort studies or case series. The most important maternal and fetal complications of the rheumatic diseases discussed are shown in the Table 1 .

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