|Year : 2016 | Volume
| Issue : 6 | Page : 115-116
Fertility and pregnancy in autoimmune rheumatic diseases
Caroline Gordon1, Molly Thabah2
1 Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
2 Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
|Date of Web Publication||22-Nov-2016|
Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gordon C, Thabah M. Fertility and pregnancy in autoimmune rheumatic diseases. Indian J Rheumatol 2016;11, Suppl S2:115-6
We are delighted to come up with the 2016 supplement issue on "Fertility and pregnancy in autoimmune rheumatic diseases." The topics covered in the supplement are important because of the practical issues faced by rheumatologists and others caring for patients as the majority of the autoimmune conditions affect women in their prime reproductive years. We thank Vinod Ravindran, Editor of the Indian Journal of Rheumatology for giving us this opportunity to guest edit this special issue. The authors for the review articles are experts in their field. The supplement begins with Dr. Rahman's review on pregnancy in antiphospholipid syndrome which is an excellent summary of the etiopathogenesis and management of pregnancy in the antiphospholipid syndrome. Antiphospholipid syndrome is a unique condition whereby obstetric criteria apart from thrombotic phenomenon are a defining feature of the syndrome, and it is of relevance to the internist, rheumatologist, and obstetricians. Recent studies show that the mechanism of pregnancy loss of antiphospholipid syndrome syndrome goes beyond placental thrombosis. Recent investigations have thrown some light on this issue and reveal the possible role of antiphospholipid (aPL) antibodies in preventing implantation of the embryo in the uterus.
Jones and Giles have done a wonderful job in writing an excellent review of fertility and pregnancy in lupus. With improvements in immunosuppressive therapies and patient survival, a greater number of patients will want to have a family, and with careful planning and management, lupus pregnancies are usually successful. However, it appears that there is still a gap in the area of pre-pregnancy counseling. Studies show that patients do not get counseling from their physicians about the most appropriate timing for pregnancies and what contraceptive measures to use to prevent unplanned pregnancy. This is more likely to be an issue in countries like India although there are no data to demonstrate this. The review on pregnancy in rheumatoid arthritis by Ostensen and Wallenius has captured all major issues related to pregnancy in rheumatoid arthritis. In particular, they highlight that not all patients will improve in pregnancy as was previously thought and patients with active inflammatory arthritis in pregnancy are at risk of premature births, small for gestational age babies, and an increased risk of cesarean section. Interestingly, population-based studies from Norway show that pregnancy complications affecting both mother and child occur more frequently in the first birth although the reasons thereof are rather unclear. What is clear though is that pregnancy outcomes tend to be good if conception occurs during disease remission or when disease activity is low.
Mukhtyar and Pathak discuss pregnancy in systemic vasculitides which are a rare group of disorders and data on pregnancy outcomes are even scarcer than in the other rheumatic diseases. There is a complex interplay of immune system dysregulation, the toxic effects of immunosuppressive therapy, poor quality of life, disability, and disease damage due to vasculitis such as chronic kidney disease that prevents pregnancies from being successful. Of note is that Takayasu's arteritis which is a large vessel vasculitis, epidemiologically more common in Asia that predominantly affects young women is a condition where rheumatologists are likely to face pregnancy-related issues. Pregnancy in systemic sclerosis poses a unique challenge in management. Renal crisis closely resembles preeclampsia. The presence of pulmonary arterial hypertension is a definite contraindication to pregnancy. In the review on pregnancy in systemic sclerosis, Vijay Rao has addressed all these issues. Ravindran and Mithun have reviewed the literature on pregnancy in lupus from India and given their perspective in the management of such patients. Of course, any discussion on pregnancy in inflammatory rheumatic diseases is incomplete without touching neonatal lupus. The review on neonatal lupus by Sathish addresses the diagnosis, management, and the potential for prevention of congenital heart block by hydroxychloroquine. Neonatal lupus is a rare condition no doubt, but all the more unfortunate that there are hardly any data on this condition from the Indian subcontinent. We conclude this supplement with a summary on the use of the nonbiologic disease-modifying antirheumatic drugs in pregnancy by Misra et al. The guidelines on prescribing in pregnancy by the British Society for Rheumatology has come at the right time and are a must read for physicians and rheumatologists alike.  These guidelines and one other by the European League against Rheumatism serve as the latest standard source of reference on this area.  While compiling this supplement, we realized that there is a need to organize epidemiological studies to assess peculiarities of pregnancy morbidity, maternal and fetal outcomes in inflammatory rheumatic diseases from low-resource settings, effects of prepregnancy counseling, how to improve outcomes, etc., [Box 1 [Additional file 1]]. We do hope the supplement would be of interest to the physicians, rheumatologists, obstetricians, nephrologist, and those who are interested in managing women with these conditions and engaging in research in the field.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, et al.
BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: Standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford) 2016;55:1693-7.
Götestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al.
The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016;75:795-810.
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