SP0110 WIN: PREGNANCY ISSUES IN PATIENTS WITH RHEUMATIC DISEASES: THE OB PERSPECTIVE FOR RHEUMATOLOGISTS
Authors: Catherine Nelson-Piercy
Journal: Annals of the Rheumatic Diseases (2019)

<h3></h3> Pregnancy issues in patients with rheumatic diseases: the OB perspective for rheumatologists <h3>Learning Objectives:</h3> Understand the importance of pre pregnancy counselling for women with rheumatic disease in pregnancy Understand the risk factors for adverse pregnancy outcome in women with rheumatic disease Understand the medications which are compatible with use in pregnancy and lactation Understand the management of rheumatic disease in pregnancy <h3>Abstract:</h3> Rheumatic disease predominantly affects women of child-bearing age and are commonly encountered in obstetric practice. Pregnancy poses an important challenge for doctors looking after these women. Knowledge about medication safety, the effect of pregnancy on the disease, and vice versa, together with pre-conception counselling and multidisciplinary team care, are important to provide the best obstetric and medical care to these women. Women with rheumatic have increased risks of miscarriage, preterm delivery, pre-eclampsia, fetal growth restriction, and disease flare in pregnancy. The main risk factor for adverse pregnancy outcomes in inflammatory arthritides is active disease/flare. For women with SLE the risks are lupus nephritis, particularly with CKD class 3-5, anti Ro/La antibodies, active disease and antiphospholipid antibodies. The most important issues of delaying pregnancy until there is quiescent disease, ensuring continued remission by continuation of drugs that are safe in pregnancy and adequately and promptly treating any flare of disease will be discussed. Adequate surveillance of the mother and fetus is imperative, but stratification of women is important to ensure that those with low risk pregnancies are not over medicalized. There is an understandable reluctance to prescribe drugs, particularly immunosuppressant drugs, in pregnancy and in breast feeding mothers. However much harm can result if drugs are withdrawn, omitted or the dose reduced inappropriately. Active disease has an adverse effect on female fertility and time to pregnancy aw well as impacting adversely on pregnancy outcomes. Guidelines from the British Society of Rheumatology and EULAR have reviewed the safety data for antirheumatic drugs in pregnancy. These publications include recommendations for which drugs are compatible with pregnancy and during lactation. These guidelines should reduce errors of omission where important medication for disease control are discontinued prior to or in pregnancy and empower rheumatologists to help women to time their pregnancies during disease remission and with continuation of medications including biologics compatible with pregnancy. <h3>References:</h3> [1] Ateka-Barrutia O, Nelson-Piercy C. Connective tissue disease in pregnancy. Clin Med. 2013; 13: 580-4. Soh MC, Nelson-Piercy C. High-risk pregnancy and the rheumatologist. Rheumatology (Oxford). 2015 Apr;54(4):572-87. doi: 10.1093/rheumatology/keu394. Epub 2014 Dec 3. [2] Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, Arthanari S, Cunningham J, Flanders L, Moore L, Crossley A, Purushotham N, Desai A, Piper M, Nisar M, Khamashta M, Williams D, Gordon C, Giles I; BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Part II: analgesics and other drugs used in rheumatology practice. Rheumatology (Oxford). 2016 Jan 10. pii: kev405. [3] Götestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, da Silva J, Nelson-Piercy C, Cetin I, Costedoat-Chalumeau N, Dolhain R, Förger F, Khamashta M, Ruiz-Irastorza G, Zink A, Vencovsky J, Cutolo M, Caeyers N, Zumbühl C, Østensen M. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016 May;75(5):795-810. doi: 10.1136/annrheumdis-2015-208840. Epub 2016 Feb 17. <h3>Disclosure of Interests:</h3> Catherine Nelson-Piercy Consultant for: UCB, Speakers bureau: UCB