Management of Rheumatologic Diseases in Pregnancy

Oier Ateka-Barrutia; Catherine Nelson-Piercy

Disclosures

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

In This Article

Fertility

Fertility in women with rheumatic diseases is generally not affected, although patients with chronic kidney disease (CKD 3–5; eGFR <50 ml/min), amenorrhea due to previous high cumulative dose of cyclophosphamide (CYC) and/or active disease may have reduced fertility.[1]

Women with RA, scleroderma and other arthritides have lower birth rates compared with the general population,[2] probably because of diminished sexual relationships as a result of joint pains, reduced joint mobility, fatigue, depression, dyspareunia, reduced libido and altered body image.[3] Concerns about possible deleterious long-term effects of pregnancy on the disease, and teratogenic effects of treatment may also discourage both doctors and patients from the challenge of pregnancy.

Patients who take NSAIDs should be encouraged to stop when trying to conceive because of the risk of luteinized unruptured follicle syndrome.[4] This condition is a well-described anovulatory state characterized by clinical signs of ovulation in the absence of follicular rupture and ovum release due to inhibition of the cyclo-oxygenase-2 needed during follicular development.

Regardless of the cause of infertility, women who are keen to undergo assisted reproductive techniques should be counseled about the increased risk of disease flare (particularly women with SLE) and thromboembolic events[5] (especially in women with ovarian hyperstimulation syndrome, antiphospholipid antibodies (aPL) and/or other prothrombotic risk factors). Identification of high-risk patients, precycle counseling, and adequate thromboprophylaxis and surveillance are mandatory.[6] In patients with SLE and antiphospholipid syndrome [APS], ovarian stimulation with clomiphene, single embryo transfer, avoidance of ovarian hyperstimulation syndrome and use of natural estradiol and/or progestagens through a nonoral route have been suggested as safe approaches.[6]

processing....