REVIEW - Pregnancy and reproduction in autoimmune rheumatic diseases

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Rheumatology (2011) 50 (4): 657-664.

doi: 10.1093/rheumatology/keq350

Pregnancy and reproduction in autoimmune rheumatic diseases

Monika Østensen1, Brucato2, Carp3, Chambers4,

Radboud J. E. M. Dolhain5, Doria6, Frauke Förger1, Caroline

Gordon7, Sinuhe Hahn8, Munther Khamashta9, D. Lockshin10,

Marco Matucci-Cerinic11, Pierluigi Meroni12, J. Lee 13, Ann

Parke14, Petri15, Luigi Raio16, Guillermo Ruiz-Irastorza17,

Clovis A. Silva18, Tincani19, M. Villiger1, Dorothea

Wunder20 and Maurizio Cutolo21

+ Author Affiliations

1Department of Rheumatology and Clinical Immunology/Allergology,

University Hospital of Bern, Bern, Switzerland, 2Department of

Internal Medicine, Ospedale Riuniti, Bergamo, Italy, 3Department of

Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer and Tel

Aviv University, Tel Aviv, Israel, 4Department of Pediatrics,

University of California San Diego, La Jolla, CA, USA, 5Department of

Rheumatology, Erasmus University Medical Center, Rotterdam, The

Netherlands, 6Department of Clinical and Experimental Medicine,

Division of Rheumatology, University of Padova, Padova, Italy,

7Department of Rheumatology, Division of Immunity and Infection,

Centre for Immune Regulation, University of Birmingham, Birmingham,

UK, 8Laboratory for Prenatal Medicine and Gynecological Oncology,

Women’s Hospital/Department of Biomedicine, Basel University Hospital,

Basel, Switzerland, 9Lupus Research Unit, The Rayne Institute, St

’ Hospital, London, UK, 10Joan and Sanford Weill College of

Medicine of Cornell University, Barbara Volcker Center for Women and

Rheumatic Disease, Hospital for Special Surgery, New York, NY, USA,

11Department of Medicine, Division of Rheumatology, Villa Monna Tessa,

University of Firenze, Firenze, 12Department of Internal Medicine,

University of Milan, Milan, Italy, 13Immunogenetics, Clinical Research

Division, Fred Hutchinson Cancer Research Center, Seattle, WA,

14Division of Rheumatic Diseases, Sr Francis Hospital and Medical

Center, Hartford, CT, 15Division of Rheumatology, Lupus Center, s

Hopkins University School of Medicine, Baltimore, MD, USA,

16Department of Obstetrics and Gynecology, University Hospital of

Bern, Bern, Switzerland, 17Department of Internal Medicine, Hospital

de Cruces, University of The Basque Country, Bizkaia, Spain,

18Pediatric Rheumatology Unit of Children’s Hospital and Division of

Rheumatology, Faculty of Medicine, University of São o, Sao o,

Brazil, 19Department of Rheumatology and Clinical Immunology, Ospedale

Civile and University of Brescia, Brescia, Italy, 20Department of

Obstetrics and Gynecology, University Hospital of Lausanne, Lausanne,

Switzerland and 21Research Laboratories and Academic Unit of Clinical

Rheumatology, Department of Internal Medicine, University of Genova,

Genova, Italy.

Abstract

Despite evidence for the important role of oestrogens in the aetiology

and pathophysiology of chronic immune/inflammatory diseases, the

previous view of an unequivocal beneficial effect of oestrogens on RA

compared with a detrimental effect on SLE has to be reconsidered.

Likewise, the long-held belief that RA remits in the majority of

pregnant patients has been challenged, and shows that only half of the

patients experience significant improvement when objective disease

activity measurements are applied. Pregnancies in patients with SLE

are mostly successful when well planned and monitored

interdisciplinarily, whereas a small proportion of women with APS

still have adverse pregnancy outcomes in spite of the standard

treatment. New prospective studies indicate better outcomes for

pregnancies in women with rare diseases such as SSc and vasculitis.

Fertility problems are not uncommon in patients with rheumatic disease

and need to be considered in both genders. Necessary therapy, shortly

before or during the pregnancy, demands taking into account the health

of both mother and fetus. Long-term effects of drugs on offspring

exposed in utero or during lactation is a new area under study as well

as late effects of maternal rheumatic disease on children.

http://rheumatology.oxfordjournals.org/content/50/4/657.abstract?etoc

Not an MD