rheumatologic disorders in pregnancy

Complications

• increased risk of pre-eclampsia/eclampsia
• anti-rheumatic agents, especially DMARDs may be teratogenic

Management

• preconception counseling in necessary
• fertility of women with rheumatoid arthritis is compartable to normal patients
• 75% of women with rheumatoid arthritis experience spontaneous remission of symptoms, generally beginning in the second trimester
• discontinue DMARDs prior to conception
  • exceptions may be hydroxychloroquine & sulfasalazine
  • most women can safely discontinue therapy for rheumatoid arthritis during pregnancy
  • discontinue methotrexate 3 months prior to conception
  • low-dose prednisone, hydroxychloroquine & sulfasalazine may be used during pregnancy if necessary
• NSAIDs may be continued during the first & second trimesters but should be discontinued in the third trimester because of the risk of premature closure of the ductus arteriosus in utero
• TNF-alpha inhibitors (infliximab, etanercept, & adalimumab) & calcineurin inhibitors (tacrolimus, cyclosporine) may be continued during pregnancy
• abatacept, rituximab, & mycophenolate must be discontinued before pregnancy
• most pregnant women with rheumatoid arthritis experience a flare after delivery, thus DMARD therapy should be restarted immediately after delivery unless the woman is breastfeeding
• with severe rheumatoid arthritis, breastfeeding should be avoided & DMARD therapy restarted

More general terms

• pregnancy disorder; obstetric disorder; pregnancy complication
• rheumatologic disease