New effective therapies have made it possible for many patients with rheumatic disease (RD) to consider having children. Living with a chronic disease means a lot of uncertainty in regard to the future, so the patient needs to plan many things much more carefully than healthy people. Having a family is one of the options in life that should be planned in case of RD. Given the fact that RDs often have an undulating disease course with good and bad days, and that medication use to control disease activity is necessary over prolonged periods of time, family planning is crucial. Studies have shown that pregnancies that occur during very active disease carry the risk of a worsening of disease in the mother and of unfavourable outcomes for the child. Therefore conception should take place during a period of remission or low disease activity. Therapy with drugs should be stable and consist of medications that are compatible with pregnancy. A clinical assessment by the rheumatologist will reveal particular risks for a future pregnancy, and which measures can be taken to reduce them.
Taking drugs during pregnancy is often a great concern for the mother, therefore a discussion with the rheumatologist already before a planned pregnancy is important. Only few dugs administered for RD can harm the child, and these must be discontinued before pregnancy. However, a patient should not stop any medication without having consulted with her physician. A flare of disease may occur after the sudden stop of a medication. Some drugs protect against a worsening of disease and should therefore be continued during pregnancy.
Management of pregnancy in a patient with RD requires collaboration of several specialists including the rheumatologist, obstetrician, and sometimes a paediatrician as well. The patient should ensure that the health professionals involved in her care know of each other and take contact with each other. In case collaboration is neglected the patient may get confused by contradictory advice, experience repetition of laboratory tests that already have been taken by one specialist or suffer a delay of treatment because none of the specialists knows for sure which responsibility he or she should have. To establish good interaction between the doctors, nurses, midwives and others is really important for the pregnant patient.
The key messages for a successful pregnancy are:
– Plan pregnancy
– Take a pre-pregnancy counselling with the doctors involved in your care
– Don't stop all medication before pregnancy
– Facilitate good collaboration between the specialists who manage your pregnancy
Østensen M. Contraception and pregnancy counseling in rheumatoid arthritis. Curr Op Rheumatol 2014; 26(3): 302-7.
Disclosure of Interest None declared