Reproductive Health in the Rheumatic Diseases
• Few conditions in rheumatology are fraught with greater concern and more unknowns than those of patients’ fertility and pregnancy. • Understanding the physiology of normal pregnancies is essential to interpreting data from patients with rheumatic disease who are pregnant. • Women with rheumatic disease are prone to special problems during the peri-conception period and puerperium because of the effects of pregnancy on their underlying disease, the impact of their underlying disease on pregnancy, and the influence of medications on both. • Women with systemic lupus erythematosus (SLE) should avoid pregnancy for at least 6 months following a period of active disease. • Most women with SLE can have successful pregnancies that are not complicated by severe flares. • The differentiation of preeclampsia from a lupus flare often poses significant challenges in the third trimester. • The presence of a lupus anticoagulant (LA) and triple positivity for antiphospholipid antibodies (aPLs) are both major risk factors for poor pregnancy outcomes in obstetric APS. • Arthritis for some women with RA improves significantly during pregnancy, but disease flares occur in others, perhaps related in part to discontinuation of medications. Disease flares following pregnancy occur in a high percentage of RA patients and should be anticipated.
