Rheumatic Diseases in Pregnancy
Women with pre-existing rheumatic disease who are planning a pregnancy and women who develop these disorders during pregnancy require specialized care by specialists in both maternal-fetal medicine and rheumatology. Depending on the underlying rheumatologic disorder and the severity of symptoms, other disciplines such as nephrology, cardiology, neurology and other specialties may also be closely involved in the care of both the mother and the baby. Optimal disease control should be achieved prior to pregnancy, and adjustments in medication and vitamin supplements should also be performed prior to conception. Mothers should not reduce or discontinue medications on their own.
Women with autoantibody abnormalities, including antiphospholipid antibodies and antinuclear antibodies, may be evaluated for these abnormalities as they apply to infertility and pregnancy risk.
A detailed prenatal care plan should address the mother’s individual health issues. Ideally, medication adjustments and planning are started before or early in the pregnancy. The mother’s symptoms need to be monitored and rheumatic disease flares should be quickly and effectively managed by the team throughout pregnancy.
An individual delivery plan will be developed by the multidisciplinary medical team, including experts in maternal-fetal medicine, rheumatology, and anesthesiology. Symptoms related to rheumatic diseases may worsen after delivery, and flares may occur. Postpartum care will be coordinated with the ongoing providers for the mother and the baby after delivery and discharge from the hospital.
Causes and Risk Factors
Rheumatic diseases that put a potential mother and baby at high-risk can include:
- Lupus
- Rheumatoid Arthritis
- Psoriatic arthritis
- axSpa
- Other conditions, such as ANA abnormalities
Symptoms
While the symptoms of some rheumatic diseases, such as RA, may improve during pregnancy, other disorders, such as systemic lupus erythematosus, are more likely to flare. Moreover, pregnancy itself can cause symptoms of joint pain and fatigue that mimic rheumatologic disorders.
Diagnosis
For women with pre-existing rheumatic disease, planning with the medical team should begin before conception in order to understand how to best manage these conditions during pregnancy.
If you have never been diagnosed with a rheumatic disease and start experiencing symptoms while pregnant or planning to conceive, it is important to get an evaluation with a rheumatologist as soon as possible to reduce the chance of experiencing pregnancy complications.
References:
- EULAR
- American College of Rheumatologists
- WHO