Management of Rheumatologic Diseases in Pregnancy

Oier Ateka-Barrutia; Catherine Nelson-Piercy


Int J Clin Rheumatol. 2012;7(5):541-558. 

In This Article


The changes in hormonal profiles found in pregnancy induce important immunomodulatory changes with direct consequences on immune-mediated rheumatic diseases. As a result of the shift from Th1 to Th2 lymphocyte dominance, Th1 predominant diseases, such as rheumatoid arthritis (RA), are more likely to remain in remission during pregnancy, whereas autoimmune disorders, such as systemic lupus erythematosus (SLE), characterized by a Th2 response, are more likely to flare.

Not all pregnancies in women with rheumatic diseases should be considered a priori high risk. Preconception counseling provides the ideal scenario as the woman's previous obstetric history, organ damage, disease activity, serological profile and additional medical history can be assessed to allow individualized discussion of potential pregnancy complications. In addition, any necessary medication adjustments can be made. Close surveillance throughout pregnancy and the puerperium, and a tailored management approach lead to high rates of successful pregnancies in these women.