Rheumatic diseases are frequently noticed in females particularly in childbearing years.
The relevance of female sex hormones like estrogens in the pathogenesis of the rheumatic diseases' initiation and development has been confirmed by their increased prevalence in females. The fact that periods of altered hormonal status like menstrual cycle, pregnancy, menopause and use of oral contraceptives have an influence on rheumatic diseases is now coming to light.
AdvertisementRheumatic diseases in pregnancy may improve, worsen from current state or remain unchanged. Studies indicate that rheumatoid arthritis improves during pregnancy and flares up following delivery. However, patients with ankylosing spondylitis are not markedly affected by pregnancy. In case of Systemic Lupus Erythematosus (SLE), pregnancy could result in the disease remaining active or in a flare up of the disease. The fetus may also suffer from complications of lupus including congenital heart disease due to spread of antibodies from the mother to the fetus. Primary anti-phospholipid antibody syndrome (APS) could result in recurrent pregnancy losses. The prognosis however has improved with the use of low dose aspirin and anticoagulation. SLE and APS also increase the risk of pre-eclampsia in the mother. Systemic sclerosis (SSc) could result in premature delivery of the fetus, though patients with stable and mild disease could have an uneventful pregnancy. Patients with vasulitis like Behcet's syndrome, Takayasu arteritis and Churg-Strauss syndrome usually have a successful pregnancy and delivery if the disease is well controlled. Besides pregnancy, fertility in males as well as females is affected by rheumatic diseases.
The prediction about the status of pregnancy outcome (like fetal growth retardation, pre eclampsia) and their relation with rheumatic diseases is being studied in the PROMISSE (predictors of pregnancy outcome: biomarkers in antiphospholipid syndrome and systemic lupus erythematosus) study.
Preconceptional counseling as well as well-coordinated medical and obstetric care is essential for improving the outcomes of pregnancy in patients suffering from autoimmune diseases. The aftermaths of the rheumatic disorders as well as of the medications taken for the disease on children also requires adequate attention.
Source: Pregnancy and Reproduction in Autoimmune Rheumatic Disease. Monika Ostensen; Antonio Brucato; Howard Carp; Christina Chambers; Radboud J. E. M. Dolhain; et al. Rheumatology 2011;50(4):657-664.