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Many rheumatologic diseases affect young women of childbearing age. Pregnancy alters immune status and is always a cause of concern in this age group. Effective use of better drugs and rigorous monitoring can now lead to remission of disease activity in many cases. Safe pregnancy and healthy child are thus possible in most cases with controlled disease activity. This issue must be carefully discussed before planning a pregnancy in every patient desirous of childbearing. Pregnancy in rheumatic diseases requires a multidisciplinary, coordinated approach for the best possible outcome.
Pregnancy-related issues of some important rheumatologic diseases are listed below
- Rheumatoid Arthritis (RA) : A lower birthrate in patients with RA is possibly due to patients' choices to limit family size rather than the effect of the disease on fertility. Disease activity decreases during pregnancy in 75-95% of patients. The improvement starts in the first trimester and continues till delivery. There is no evidence of fetal growth retardation or increased incidence of abortions. No special monitoring is required during pregnancy. Drugs such as methotrexate and leflunomide must be discontinued for 3 and 24 months, respectively, before planning a pregnancy. Pain control during pregnancy with RA should be achieved with safe drugs and non-pharmacologic measures (rest, splints, fomentation, icepack, etc.). RA is known to flare up after delivery. It is common to find a new-onset RA following delivery. Use of some of the anti-rheumatic agents is possible after delivery with properly timed breastfeeding.
- Systemic Lupus Erythematosus (SLE) :Patients with SLE appear to be less fertile due to the disease (irregular or no menses) or due to the effect of drugs (glucocorticoids and cyclophosphamide). Patients on cyclophosphamide are less likely to develop infertility (failure of ovaries) if cyclophosphamide is started at a younger age. Careful monitoring after week 16 is, therefore, advisable. These antibodies are usually destroyed with the first six months of life.
- Ankylosing spondylitis and other spondyloarthropathies : Pregnancy improves peripheral arthritis and eye problems but worsens back pain. An increase in back pain is possibly due to mechanical causes.