Women with rheumatic diseases, including systemic lupus erythematosus (SLE or lupus), rheumatoid arthritis (RA), psoriatic arthritis, vasculitis, antiphospholipid syndrome, and other rheumatic conditions, can face unique challenges during pregnancy.
While the symptoms of some rheumatic diseases, such as RA, may improve during pregnancy, other disorders, such as systemic lupus erythematosus, are more likely to flare. Moreover, pregnancy itself can cause symptoms of joint pain and fatigue that mimic rheumatologic disorders. Women with SLE, and in some cases, RA, are at greater risk for pregnancy complications such as preeclampsia, preterm delivery and low birthweight infants.
Finally, management of women with rheumatologic disorders during pregnancy can be challenging, as many of the medications traditionally used to treat rheumatic disease are contraindicated during pregnancy.
At Brigham and Women’s Hospital (BWH), we provide highly specialized care for women with rheumatic diseases before, during, and after pregnancy. Our team of experts, including maternal-fetal medicine (high-risk pregnancy) specialists, rheumatologists, nephrologists, anesthesiologists, and specialized nurses, is dedicated to delivering the highest level of care for both the mother and her baby. We also offer evaluation of women with autoantibody abnormalities, including antiphospholipid antibodies and antinuclear antibodies, as they apply to infertility and pregnancy risk.
Women with pre-existing rheumatic disease who are planning a pregnancy and women who develop these disorders during pregnancy require specialized care by specialists in both maternal-fetal medicine and rheumatology. Depending on the underlying rheumatologic disorder and the severity of symptoms, other disciplines such as nephrology, cardiology, neurology and other specialties may also be closely involved in the care of both the mother and the baby.
For women with pre-existing rheumatic disease, planning with the medical team should begin before conception in order to understand how to best manage these conditions during pregnancy. Optimal disease control should be achieved prior to pregnancy, and adjustments in medication and vitamin supplements should also be performed prior to conception. Mothers should not reduce or discontinue medications on their own.
A detailed prenatal care plan should address the mother’s individual health issues. Ideally, medication adjustments and planning are started before or early in the pregnancy. The mother’s symptoms need to be monitored and rheumatic disease flares should be quickly and effectively managed by the team throughout pregnancy.
An individual delivery plan will be developed by the multidisciplinary medical team, including experts in maternal-fetal medicine, rheumatology, and anesthesiology. Symptoms related to rheumatic diseases may worsen after delivery, and flares may occur. Postpartum care will be coordinated with the ongoing providers for the mother and the baby after delivery and discharge from the hospital.
At Brigham and Women’s Hospital, experts in maternal-fetal medicine and rheumatology have formed an innovative collaboration to provide advanced, highly specialized care for women with rheumatic diseases before, during, and after pregnancy. In addition to maternal-fetal medicine specialists and rheumatologists, our multidisciplinary team includes nephrologists, anesthesiologists, specialized nurses, and social workers – all dedicated to delivering the highest level of care for both the mother and her baby.