Pregnancy considerations are important for women with arthritis and for those with rheumatic diseases who have concerns about pregnancy. Some women with rheumatic diseases are even advised not to have children.
This fear comes from a lack of understanding of the interaction between rheumatic diseases and pregnancy. If you currently have arthritis and you are pregnant or planning to become pregnant, it is best to know these pregnancy considerations.
1. Pregnancy in women with arthritis or other rheumatoid diseases can go well with close clinical monitoring and proper medical management.
They need an obstetrician to handle the pregnancy and a rheumatologist to handle their rheumatic disease, which is important for women with arthritis. With the right teamwork, having a smooth pregnancy is not a dream, but not all pregnant women are free of complications during pregnancy.
2.The effect of pregnancy on rheumatic diseases should be analyzed in specific problems
Pregnant women with rheumatoid arthritis, lupus, antiphospholipid syndrome and other rheumatic diseases have different characteristics and precautions.
①The typical characteristic of pregnant women with rheumatoid arthritis is that the symptoms are relieved during pregnancy and reappear after delivery, during the period of symptom remission, drug reduction or discontinuation can be considered.
(ii) Pregnant women with lupus are typically characterized by mild to moderate lupus flares both during pregnancy and after delivery.
③Antiphospholipid syndrome is an autoimmune disease that manifests as the body producing antibodies against its own phospholipids or plasma proteins. The disease can be complicated by systemic lupus erythematosus or other rheumatic diseases, which can increase the risk of thrombosis, miscarriage, and hypertension during pregnancy, and the period around the delivery period is quite critical.
④Pulmonary hypertension is sometimes complicated by scleroderma, Sjogren’s syndrome, lupus and antiphospholipid syndrome, which can be aggravated by pregnancy, which is why such patients are advised not to become pregnant.
⑤ Other rheumatic diseases include scleroderma without complications of pulmonary hypertension, polymyositis, dermatomyositis and vasculitis, which are characterized by the fact that they are not affected by pregnancy if properly controlled.
3. Pregnant women with renal disease associated with vasculitis, scleroderma or lupus are at increased risk of developing severe gestational hypertension and preeclampsia
If the patient’s kidney function and blood pressure are normal before conception, and the rheumatic disease is in stability or remission for up to 6 months from conception, then it is also possible that everything will go well during pregnancy. On the contrary, women with abnormal kidney function, poorly controlled blood pressure, and active rheumatic disease are usually advised not to get pregnant.
4. A small percentage of babies born to pregnant women with anti-RO antibodies will have congenital heart block
Anti-Ro antibodies are most common in patients with lupus and Sjogren’s syndrome. These antibodies enter the fetal bloodstream and slow the fetal heart rate, sometimes requiring the baby to eventually have a pacemaker. The presence of anti-La antibodies during pregnancy can also be a problem.
5. Inflammation and anti-inflammatory drugs that are evident during active rheumatic disease are also a major problem during pregnancy
It is best for women during pregnancy and parenting not to take any medications, but if inflammation is evident, if the medication used to control the condition of the pregnant woman is to be withdrawn, then the potential impact of the medication on the fetus in the womb and the impact of not using the medication on the health of the pregnant woman must be weighed.
6, the use of anti-rheumatic drugs during pregnancy and lactation, which is safe and which is harmful has been the consensus.
Many obstetricians, rheumatologists and internists experienced in the treatment of pregnant women with rheumatic diseases have reached a consensus on the anti-rheumatic drugs available during pregnancy and lactation.
Medications available during both pregnancy and lactation include: nonsteroidal anti-inflammatory drugs (until 32 weeks of pregnancy)
Lyuzoxapyridine
Chloroquine (hydroxylated chloroquine)
Corticosteroids (preferably 10 mg or less) Drugs available during pregnancy but controversial during lactation include: Cyclosporine A
Imuran (azathioprine) Medications not available during both pregnancy and lactation include: methotrexate
Sanxidol (mescaline)
Cyclophosphamide (cyclophosphamide)
Anti-TNF drugs (etanercept, infliximab, adalimumab)
Meroval (rituximab)
7. Women who are preparing to become pregnant should have their rheumatic diseases under control for at least 3 to 6 months before conception.
It is recommended that all women preparing for pregnancy consult with a rheumatologist and obstetrician prior to pregnancy, so that the risk of complications can be assessed and a treatment plan for rheumatism during pregnancy can be developed, as well as protective measures during pregnancy.
Women with low risk of complications should also see a rheumatologist regularly once every three months to properly assess their condition and change their management strategy in a timely manner.
Women at high risk of complications should rely even more on an obstetric team experienced in managing high-risk pregnancies. They will require multiple observations and close monitoring as the pregnancy progresses. Conditions in high-risk pregnancies include
kidney injury
Heart disease
Pulmonary artery hypertension
Restrictive lung disease
Active rheumatic disease
In vitro fertilization
Multiple births
Pre-existing obstetrical problems