Periconceptional Counselling in Women with Autoimmune Inflammatory Rheumatic Diseases

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 May 11

PMID 38731018

Authors

Klara Rosta

Julia Binder

Valerie Kuczwara

Mira Horvath

Florian Heinzl

Christina Horhager

Daniel Mayrhofer

Peter Mandl

Ruth Fritsch-Stork

Johannes Ott

Antonia Mazzucato-Puchner

Affiliations

Soon will be listed here.

Abstract

Systemic autoimmune rheumatic diseases (SARDs) in pregnancy represent a complex challenge for both patients and healthcare providers. Timely preparation for pregnancy enables adequate disease control, thereby reducing the risk of disease flare and pregnancy complications. Interdisciplinary care starting from the pre-pregnancy period throughout pregnancy and during breastfeeding ensures better fetal and maternal outcomes. This review provides a comprehensive guide to pre-pregnancy counselling in SARDs, an overview of medication management strategies tailored to pregnancy, disease activity and pregnancy monitoring in patients, and the promotion of shared decision making between healthcare providers and patients. Guidelines from international organizations were selected to provide a basis for this review and guidance through the quintessential discussion points of care.

References

Tian J, Zhang D, Yao X, Huang Y, Lu Q . Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study. Ann Rheum Dis. 2022; 82(3):351-356. PMC: 9933169. DOI: 10.1136/ard-2022-223035. View

Skorpen C, Lydersen S, Gilboe I, Skomsvoll J, Salvesen K, Palm O . Women with systemic lupus erythematosus get pregnant more easily than women with rheumatoid arthritis. Rheumatology (Oxford). 2018; 57(6):1072-1079. DOI: 10.1093/rheumatology/key049. View

de Man Y, Bakker-Jonges L, Goorbergh C, Tillemans S, Hooijkaas H, Hazes J . Women with rheumatoid arthritis negative for anti-cyclic citrullinated peptide and rheumatoid factor are more likely to improve during pregnancy, whereas in autoantibody-positive women autoantibody levels are not influenced by pregnancy. Ann Rheum Dis. 2009; 69(2):420-3. DOI: 10.1136/ard.2008.104331. View

Bairkdar M, Rossides M, Westerlind H, Hesselstrand R, Arkema E, Holmqvist M . Incidence and prevalence of systemic sclerosis globally: a comprehensive systematic review and meta-analysis. Rheumatology (Oxford). 2021; 60(7):3121-3133. PMC: 8516513. DOI: 10.1093/rheumatology/keab190. View

He W, Wei H . Maternal and fetal complications associated with systemic lupus erythematosus: An updated meta-analysis of the most recent studies (2017-2019). Medicine (Baltimore). 2020; 99(16):e19797. PMC: 7440247. DOI: 10.1097/MD.0000000000019797. View

Alamanos Y, Tsifetaki N, Voulgari P, Venetsanopoulou A, Siozos C, Drosos A . Epidemiology of primary Sjögren's syndrome in north-west Greece, 1982-2003. Rheumatology (Oxford). 2005; 45(2):187-91. DOI: 10.1093/rheumatology/kei107. View

Meissner Y, Fischer-Betz R, Andreoli L, Costedoat-Chalumeau N, De Cock D, Dolhain R . EULAR recommendations for a core data set for pregnancy registries in rheumatology. Ann Rheum Dis. 2020; 80(1):49-56. PMC: 7788063. DOI: 10.1136/annrheumdis-2020-218356. View

Zarek S, Mitchell E, Sjaarda L, Mumford S, Silver R, Stanford J . Is Anti-Müllerian Hormone Associated With Fecundability? Findings From the EAGeR Trial. J Clin Endocrinol Metab. 2015; 100(11):4215-21. PMC: 4702454. DOI: 10.1210/jc.2015-2474. View

Forger F, Vallbracht I, Helmke K, Villiger P, Ostensen M . Pregnancy mediated improvement of rheumatoid arthritis. Swiss Med Wkly. 2012; 142:w13644. DOI: 10.4414/smw.2012.13644. View

10.

Puchner A, Grochenig H, Sautner J, Helmy-Bader Y, Juch H, Reinisch S . Immunosuppressives and biologics during pregnancy and lactation : A consensus report issued by the Austrian Societies of Gastroenterology and Hepatology and Rheumatology and Rehabilitation. Wien Klin Wochenschr. 2019; 131(1-2):29-44. PMC: 6342891. DOI: 10.1007/s00508-019-1448-y. View

11.

Tan Y, Yang S, Liu Q, Li Z, Mu R, Qiao J . Pregnancy-related complications in systemic lupus erythematosus. J Autoimmun. 2022; 132:102864. DOI: 10.1016/j.jaut.2022.102864. View

12.

Hollestelle M, van der Graaf R, Sturkenboom M, van Delden J . Stimulating solidarity to improve knowledge on medications used during pregnancy : A contribution from the ConcePTION project. BMC Med Ethics. 2023; 24(1):44. PMC: 10304330. DOI: 10.1186/s12910-023-00924-x. View

13.

Schreiber K, Giles I, Costedoat-Chalumeau N, Nelson-Piercy C, Dolhain R, Mosca M . Global comment on the use of hydroxychloroquine during the periconception period and pregnancy in women with autoimmune diseases. Lancet Rheumatol. 2024; 5(9):e501-e506. DOI: 10.1016/S2665-9913(23)00215-1. View

14.

de Man Y, Hazes J, van der Heide H, Willemsen S, de Groot C, Steegers E . Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum. 2009; 60(11):3196-206. DOI: 10.1002/art.24914. View

15.

Rees F, Doherty M, Grainge M, Lanyon P, Zhang W . The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology (Oxford). 2017; 56(11):1945-1961. DOI: 10.1093/rheumatology/kex260. View

16.

Jethwa H, Lam S, Smith C, Giles I . Does Rheumatoid Arthritis Really Improve During Pregnancy? A Systematic Review and Metaanalysis. J Rheumatol. 2018; 46(3):245-250. DOI: 10.3899/jrheum.180226. View

17.

Miedany Y, Palmer D . Rheumatology-led pregnancy clinic: enhancing the care of women with rheumatic diseases during pregnancy. Clin Rheumatol. 2020; 39(12):3593-3601. PMC: 7648739. DOI: 10.1007/s10067-020-05173-6. View

18.

Malhame I, DSouza R, Cheng M . The Moral Imperative to Include Pregnant Women in Clinical Trials of Interventions for COVID-19. Ann Intern Med. 2020; 173(10):836-837. PMC: 7384266. DOI: 10.7326/M20-3106. View

19.

Crossfield S, Marzo-Ortega H, Kingsbury S, Pujades-Rodriguez M, Conaghan P . Changes in ankylosing spondylitis incidence, prevalence and time to diagnosis over two decades. RMD Open. 2021; 7(3). PMC: 8663075. DOI: 10.1136/rmdopen-2021-001888. View

20.

Fischer-Betz R, Specker C, Brinks R, Aringer M, Schneider M . Low risk of renal flares and negative outcomes in women with lupus nephritis conceiving after switching from mycophenolate mofetil to azathioprine. Rheumatology (Oxford). 2013; 52(6):1070-6. DOI: 10.1093/rheumatology/kes425. View