Dr. Lisa Sammaritano from Weill Cornell Medical College has explained a way to lower risks within pregnancy for those with rheumatic diseases.

Pregnancy and Rheumatic Diseases

Patients who have a rheumatic disease can face complications during pregnancy. That said, advancements in medicine have lead to greater understanding of the diseases, more options for patients, and ways to improve the probability of safe conception.

Of course these options, and the risks that preclude them, are different from patient to patient and vary widely depending on the disease. In general, doctors have seen better outcomes for patients when they have low disease activity in the 6 months prior to conception. Further, better outcomes exist for those on certain medications over others.

Evaluating the Patient

Dr. Sammaritano explains that the disease severity of the patient must first be examined. This allows the doctor to understand the organ damage the patient has. Contraindications for pregnancy include renal disease/insufficiency, pulmonary hypertension, and valvular disease. Additionally, active disease can be harmful for the growing child and the mother.

But what diseases are the most concerning for pregnancy? Antiphospholipid syndrome (APS) as well as systemic lupus have the highest risks, but that doesn’t mean that a healthy pregnancy isn’t possible. APS is complicated by thrombosis.

Other conditions which could be harmful include renal disease, lupus nephritis, proteinuria, and Sjogren’s syndrome. Sjogren’s is associated with high levels of La and anti-Ro antibodies. These can cause issues during pregnancy.  Additionally, the rate of fetus survival decreases with the development of dermatomyositis or polymyositis during pregnancy. For patients who had one of these conditions before pregnancy, and were well-managed, survival rates are much higher.

Medications

Some of the medications that should not be used during pregnancy (and 6-8 weeks prior) are-

• Thalidomide
• Leflunomide
• Myophenolate
• Cyclophosphamide

Other medications can be used right up until conception. These include-

• TNF inhibitors
• Tacrolimus
• Rituxiimab
• Non-TNF biologics   

Ultimately, the best ways to improve your chances of having healthy pregnancy when you are diagnosed with a rheumatic disease is to plan your pregnancy and communicate with a doctor about care prior to conception, during pregnancy, and during postpartum/breastfeeding.

You can read more about pregnancy and these conditions here.