Rheumatic diseases in pregnancy

Abstract

Rheumatic diseases often present in women of childbearing age. Fortunately, most forms of inflammatory arthritis improve in pregnancy and maternal or fetal complications are rare. Drug therapy may need to be modified as most drugs cross the placenta but only a few are definitely teratogenic. Ankylosing spondylitis may not remit in pregnancy and can be difficult to manage as the high dose non-steroidal anti-inflammatory drugs usually taken by the patient must be discontinued. Providing that systemic lupus erythematosus is well-controlled at the onset of pregnancy, the prognosis for mother and baby is good. Neonatal lupus syndrome is uncommon. The outcome in the rarer systemic conditions such as scleroderma and vasculitis is less predictable and the risk of serious deterioration in the mother is greater. Close liaison between obstetricians and rheumatologists will ensure optimal management of these potentially complicated pregnancies.