Practical management of the pregnant patient with rheumatic disease

Rheumatic and autoimmune diseases are often present in women during the childbearing years and as such, correct management of pregnancy throughout its course is of significance to all those affected. Previously women with systemic rheumatic diseases were counselled against pregnancy as the majority of medications carried potential or perceived teratogenic risk. But in recent years new therapies have emerged that have advanced treatment. Patients have experienced significant improvements in physical function, quality of life, and reduced damage accrual. As a result, an expanded cadre of health care providers now need to be able to manage pregnancy in women with underlying rheumatic disease, both in acute or chronic settings.

Practical Management of the Pregnant Patient with Rheumatic Disease is a quick-access guide of the most up-to-date understanding of the interplay between pregnancy and rheumatic diseases and principles of management before, during and after pregnancy assisting in decision making regarding treatment of women with autoimmune diseases.

This collection of 70 cases covers pregnancy counseling, the management of disease flares, thromboembolic disease, the management of patients with end organ disease, advice on medications, obstetric complications, infections and the management of rare diseases in women with rheumatic diseases before and during pregnancy and post-partum.

The handbook provides concise recommendations for all providers who may encounter women of child-bearing age including rheumatologists, gynaecologists, paediatricians, primary care providers and health professionals dealing with pre-conceptional and pregnant women with rheumatic diseases.

Karen Schreiber, Copenhagen Lupus and Vasculitis Clinic, Copenhagen University Hospital, Denmark,Eliza Chakravarty, Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, USA,Monika ?stensen, Professor of Rheumatology, Department of Rheumatology, Sorlandet Hospital, Kristiansand, Norway

Dr Karen Schreiber main clinical and research interests are antiphospholipid syndrome and connective tissue diseases in pregnant women. Dr Schreiber is involved in identifying alternative treatment to improve fetal and maternal pregnancy outcomes in pregnant women with antiphospholipid syndrome.
Dr Schreiber is an active member of the British Society for Rheumatology (BSR) working groups publishing clinical guidelines with the overall aim to improve the treatment of patients with rheumatic diseases.

Dr. Chakravarty is a rheumatologist and epidemiologist with a longstanding clinical and research interest in understanding the interrelationships between pregnancy and underlying rheumatic diseases. She works to identify and mitigate risk factors for adverse pregnancy outcomes and to optimize medical management of chronic rheumatic diseases during pregnancy and the postpartum period in order to maximize outcomes for both mother and infant.

Dr. ?stensen is a rheumatologist with a special interest in the interaction between pregnancy and the rheumatic diseases. Her research through many years has focussed on reproduction issues of women and men with rheumatic disease; immunology of pregnancy; antirheumatic drugs during pregnancy and breastfeeding. She has established specialized centers at Rheumatology departments in Norway and in Switzerland that counsel and manage patients who plan a family or are pregnant.

Section One: Counselling
1. Important points of pre-pregnancy counselling, Monika ?stensen
Section Two: Patients with pre-pregnancy complications
2.1. Thrombotic Complications in pregnant patients with rheumatic disease, Andrew James Doyle and Beverley Jane Hunt
2.2. Prevention of postpartum venous thromboembolism (VTE), Roseann O'Doherty and Fionnuala N? Ainle
2.3. Pulmonary Arterial Hypertension, Eliza Chakravarty
2.4. Advanced renal disease / renal impairment, Hannah Blakey and Kate Bramham
2.5. Antibodies as risk factors for adverse maternal and fetal outcomes, Massimo Radin, Karen Schreiber, and Savino Sciascia
Section Three: Adjustment of therapy before/during pregnancy and lactation
3.1. Disease modifying drugs, biological drugs and concomitant medications before/during pregnancy and lactation, Monika ?stensen and Ian Giles
3.2. Managing a patient exposed to a teratogenic drug at different stages of pregnancy, Christof Schaefer
Section Four: Infection during pregnancy
4. Infection in a pregnant patient on immunosuppressive treatment, Maria Rhona G. Bergantin and Sandra V. Navarra
Section Five: Organ specific flares during pregnancy
5. Managing Organ Specific Flares, Bonnie L. Bermas and Eliza Chakravarty
Section Six: Obstetric complications in women with autoimmune diseases
6. Pregnancy and Obstetric Complications in Women with Autoimmune Diseases, D. Ware Branch
Section Seven: Vaccination before or during pregnancy
7. Vaccination before or during pregnancy, Cara D Varley and Kevin L Winthrop
Section Eight: Rare diseases in pregnancy
8.1. SLE, Karen Schreiber and Monika Ostensen
8.2. Systemic lupus erythematosus and the risk of cardiovascular disease, Karen Schreiber and Soeren Jacobsen
8.3. 3 Antiphospholipid syndrome, Karen Schreiber and Savino Sciascia
8.4. Vasculitis in Pregnancy, Megan Clowse and Jon Golenbiewski
8.5. Systemic sclerosis, Eliza Chakravarty
8.6. Myositis and Pregnancy, Muhammed Shipa and David Isenberg
8.7. Ankylosing spondylitis in pregnancy, Monika ?stensen