Pregnancy & Rheumatic Disease
Rheumatic diseases often affect women during childbearing years. With careful medical and obstetric management, most women living with rheumatic diseases can have successful pregnancies. However, women should not consider getting pregnant until their rheumatic disease is under control.
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 resulting in a reduced need for medication, but they often flare up after delivery.
Pregnancy in lupus is associated with mild to moderate flares. However, most of these flares do not endanger the mother's or the baby's life, nor do they substantially alter the long-term prognosis of lupus.
Antiphospholipid syndrome (APS) increases the risk of clots in veins and arteries as well as complications such as miscarriage, premature birth, or hypertension (high blood pressure) during pregnancy. Patients with kidney disease have a risk of developing pre-eclampsia.
Because pulmonary hypertension frequently worsens during pregnancy and postpartum, it is not advised for women with this condition to become pregnant.
Other diseases such as polymyositis, dermatomyositis, and vasculitis do not seem to be affected by pregnancy. If a patient does not have pulmonary hypertension or lung fibrosis, scleroderma does not appear to be affected by pregnancy either.What are the effects of rheumatic disease on pregnancy?
Diseases with the potential to affect the kidneys (especially SLE and APS) are more likely to affect pregnancy than those that do not.
Patients who have or have had kidney disease due to vasculitis, scleroderma, or lupus have an increased risk of severe hypertension and pre-eclampsia.
Pregnancy in women with APS should always be considered as high risk. Women with anti-Ro antibodies should be closely monitored during pregnancy.
Use of rheumatic medications during pregnancy and lactation
During pregnancy, active rheumatic disease inflammation and medications used to treat rheumatic disease can cause problems. The 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases is an important resource that can guide decision making.
Management of pregnancy in women with rheumatic diseases
Each woman’s rheumatic disease should be well under control for at least three - six months before attempting pregnancy. As long as 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 include regular three-month visits to the rheumatologist, as a precaution. Those with a high-risk profile should be managed by a medical and obstetric team with experience in high-risk pregnancies.
Updated April 2023 by Cheryl Crow, MOT, OTR/L, 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.