Table 6 Key points in the management of patients with rheumatological diseases in pregnancy

With thorough pre-pregnancy planning, most pregnancies in women with infl ammatory rheumatic diseases are low-risk and have a favorable outcome.

Fertility is generally not affected by autoimmune rheumatic disease.

Systemic lupus erythematosus is the most widely studied rheumatic disease in pregnancy, and it is important to differentiate active lupus disease from pathophysiological changes of pregnancy.

Antiphospholipid syndrome is secondary to another autoimmune disease in 50% of cases. Anti-phospholipid antibodies are associated with an increased risk of thrombosis, fetal loss, pre-eclampsia, intrauterine growth restriction, and premature labor

Rheumatoid arthritis and Behçet disease usually improve during pregnancy but are still associated with a risk of flare in the postpartum period.

Disease at the time of conception is the most important factor in determining maternal and fetal outcome.

HELLP (hemolysis, elevated liver enzymes, and low platelets) and pre-eclampsia occur in women with autoimmune rheumatic disease (especially, antiphospholipid syndrome) earlier than in healthy women and must be distinguished from disease activity and treated appropriately.

Neonatal lupus is specific to mother with anti-Ro/La antibodies and can lead to irreversible congenital complete heart block, requiring a permanent pacemaker in affected children.

Drug therapy must be reviewed prior to conception and during pregnancy and breastfeeding in order to rule out any potential harmful side effects to the fetus/child.

Vaginal delivery is generally deemed safe. Cesarean sections are reserved for patients with obstetric complications.