Pregnancy Autoimmune Rheumatic Diseases Department

75-90% of women with Rheumatoid Arthritis (RA) report symptom improvement during pregnancy. Improvement starts in the first trimester and peaks in the third trimester. However, RA usually recurs after childbirth.

In addition, new-onset RA occurs 3-5 times more frequently during this period.

In general, RA does not affect the outcome of pregnancy and the fetus. However, recent studies have correlated high disease activity during conception with prematurity and low birth weight neonates.

Pregnancy in women with RA is best to be scheduled, so that they receive medication that is compatible with it, and keep the disease in remission or under control as best possible.

The progress to date in both diagnosing and treating Lupus rarely deprives patients from becoming pregnant. So most women can become pregnant.

During pregnancy, regular monitoring is required by a rheumatologist and a gynecologist, who should work closely together.

In a small proportion of women with Systemic Lupus Erythematosus (10-20%), pregnancy, as well as the postpartum period (3 to 4 weeks following childbirth), can cause an outbreak of the disease, although it is limited and easily treated.

The chance of an outbreak is very small if conception occurs when Lupus is in remission. On the contrary, it increases when it is active. Therefore, we recommend avoiding pregnancy for as long as the disease is active and for six months after it has been in remission.

Women with severe organ involvement, such as severe pulmonary hypertension, end-stage nephritis with kidney involvement and uncontrolled seizures, are discouraged from becoming pregnant.

There are medications allowed during pregnancy and breastfeeding, while others may harm the fetus. Therefore, it is recommended that patients on such medications avoid pregnancy.

Pregnant women with Antiphospholipid Syndrome run a higher risk of thrombosis or miscarriage compared to women without this syndrome.

They may also present other problems, such as preeclampsia and reduced blood flow to the fetus.

Diagnosis and treatment depend on the patient’s previous history (thrombosis, miscarriages, intrauterine fetal death, preeclampsia) and specific laboratory findings. Generally speaking, women with thromboses or miscarriages are advised to use heparin and aspirin.

Pregnancy seems to improve peripheral arthritis and uveitis in patients with spondyloarthritis, however, patients with spinal involvement deteriorate.

In all types of vasculitis, it is necessary for the disease to already be in remission before pregnancy, and patients should only take medications that are allowed during pregnancy.

The main recommendation to women with Scleroderma is to wait a few years after the onset of the disease and then become pregnancy. During the first 3 years, the risk of heart, lung or kidney damage is increased and, therefore, pregnancy may be detrimental both to the patient and the fetus.

If internal organs are not affected during this critical period, the risk of involvement becomes distant and pregnancy is considered to be safe.

In general, the syndrome does not affect pregnancy. In this syndrome, some of the mother’s autoantibodies may pass through the placenta and create a problem to the fetus, but also to the neonate (neonatal lupus), such as skin rashes or heart rate disorders.