Pregnancy & Rheumatic Disease
Rheumatic diseases often affect women during childbearing years. With careful medical/obstetric management, most women living with rheumatic diseases can have successful pregnancies. However, women should not consider getting pregnant until their rheumatic disease is well-managed.
What Are the Effects of Pregnancy on Rheumatic Disease?
Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) typically are modified by pregnancy. RA symptoms often improve in pregnant patients, frequently reducing the need for medication, but patients often flare after delivery.
Pregnancy in lupus is associated with mild/moderate flares. However, most flares do not endanger the mother's or the baby's life, nor do they substantially alter the long-term prognosis of lupus.
APS increases the risk of clots in veins and arteries and pregnancy complications such as miscarriage, premature birth, or high blood pressure. Patients with kidney disease have a risk of developing pre-eclampsia.
Pulmonary hypertension frequently worsens during pregnancy and postpartum, so these patients are not advised to become pregnant.
Other diseases such as polymyositis, dermatomyositis, and vasculitis do not seem to be effected by pregnancy. If a patient does not have pulmonary hypertension or lung fibrosis, scleroderma also does not appear to be affected by pregnancy.
What Are the Effects of Rheumatic Disease on Pregnancy?
Patients who have or have had kidney disease due to vasculitis, scleroderma, or lupus have an increased risk of severe hypertension and pre-eclampsia during pregnancy.
Pregnancy in women with APS is considered high risk. Women with anti-Ro antibodies should be closely monitored during pregnancy as it can lead to pregnancy complications.
Use of Rheumatic Medications During Pregnancy and Lactation
During pregnancy, active rheumatic disease inflammation and the medications used to treat rheumatic disease can cause problems. Medications might need to be adjusted. The 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases can guide decision making.
Management of Pregnancy in Women with Rheumatic Diseases
Each woman’s rheumatic disease should be under control for at least 3–6 months before attempting pregnancy. If your medicines are not harmful to the fetus, you should remain on your medicines to prevent a disease flare.
Women with a low-risk profile should have regular three-month visits with rheumatology. Those with a high-risk profile should be managed by a medical and obstetric team with experience in high-risk pregnancies.
Updated April 2025 by Rebecca Fitzpatrick, MD, and reviewed by the American College of Rheumatology.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.