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Rheumatology-led pregnancy clinic: patient-centred approach

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Abstract

Autoimmune rheumatic diseases (ARDs), which include all types of inflammatory arthritis as well as systemic Lupus, are known to have a detrimental effect on both fertility and pregnancy outcomes. Consequently, reproductive health care is considered a principle constituent of comprehensive care for all patients with rheumatic ailments seen in the standard practice. Whilst pregnancy-associated complications have been reported in lupus, rheumatoid arthritis, and Sjogren’s syndrome, in some conditions such as lupus, antiphospholipid syndrome, inflammatory myopathies, and vasculitis, the pregnancy may accelerate the disease progression. Furthermore, the activity of some diseases such as lupus and antiphospholipid syndrome may be augmented by some contraceptive methods. Therapeutically, some patients are prescribed medications, such as methotrexate and mycophenolate which have potentially teratogenic effect. Therefore, to be able to help those patients, family planning should be patient-centred with decision-making tailored to the individual’s disease status. For those healthcare professionals interested in reproductive health care for their patients living with autoimmune rheumatic diseases, this review summarizes the available information in the literature and offers practical suggestions of patient-centred care in a dedicated rheumatology-led pregnancy clinic.

Key Points

• Autoimmune disorders, particularly systemic inflammatory rheumatic diseases, affect many women, often during childbearing age.

• Pregnancies in this cohort of patients with rheumatic diseases is considered to be of high risk, because of the potential for complications during periods of active disease and the possible impact of medications used on both the pregnancy outcomes as well as the baby.

• There are high chances of successful and safe pregnancies particularly if pre-pregnancy planning and screening for maternal and fetal risks are undertaken, and pregnancy takes place while the disease is well controlled. Encouraging the patients, who are in their childbearing period, to initiate discussions about family planning and pregnancy, with their treating rheumatologists, would be an ideal approach to close this gap of information exchange.

• Targeted patients’ education is expected to improve the information quality and promote more collaborative decision-making with regard to motherhood and healthcare choices.

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Authors and Affiliations

  1. King’s College London, London, UK

    Yasser El Miedany

  2. Rheumatology Department, North Middlesex University Hospital, London, UK

    Deborah Palmer

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  1. Yasser El Miedany
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  2. Deborah Palmer
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Correspondence to Yasser El Miedany.

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El Miedany, Y., Palmer, D. Rheumatology-led pregnancy clinic: patient-centred approach. Clin Rheumatol 40, 3875–3882 (2021). https://doi.org/10.1007/s10067-021-05690-y

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