Document Detail

Management of rheumatic diseases during pregnancy.
MedLine Citation:
PMID:  20463432     Owner:  NLM     Status:  MEDLINE    
Systemic rheumatic diseases commonly affect women during the childbearing years. Many women with these diseases may be contemplating pregnancy or discover an inadvertent pregnancy, leading to concerns regarding medication use, changes in disease activity during pregnancy, safety of lactation, and future ability to care for a child given the presence of chronic illnesses. There are outstanding reviews that summarize the safety and use of immunosuppressive medications during pregnancy. However, in addition to medication use, providers need to be aware of the available data regarding fertility, pregnancy outcomes, delivery, and lactation issues that may be specific to individual diseases. Optimally, women should plan pregnancies to occur around times of disease quiescence, several months after potentially teratogenic medications have been discontinued. The course of the underlying rheumatic disease during pregnancy is variable, and there are no specific clinical or laboratory variables that consistently predict disease improvement or worsening during pregnancy. Recent data suggest that increased disease activity in women with most autoimmune diseases during pregnancy may lead to increased risk of premature delivery, low-birth-weight infants, and other adverse pregnancy outcomes. Arthritis involving the cervical spine and hips may impact delivery and must be considered by both obstetricians and obstetric anesthesiologists. Data are mixed regarding the impact of breastfeeding on underlying autoimmune diseases; the choice to continue breastfeeding is a personal decision.
Amy B Elliott; Eliza F Chakravarty
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Postgraduate medicine     Volume:  122     ISSN:  1941-9260     ISO Abbreviation:  Postgrad Med     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-13     Completed Date:  2010-06-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401147     Medline TA:  Postgrad Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  213-21     Citation Subset:  AIM; IM    
Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
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MeSH Terms
Antirheumatic Agents / adverse effects
Breast Feeding
Delivery, Obstetric
Preconception Care*
Pregnancy Complications / drug therapy*
Pregnancy Outcome
Rheumatic Diseases / complications,  drug therapy*
Reg. No./Substance:
0/Antirheumatic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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