Rheumatology-led pregnancy clinic: patient-centred approach

Autoimmune rheumatic diseases (ARDs), which include all types of inflammatory arthritis as well as systemic Lupus, are known to have a detrimental effect on both fertility and pregnancy outcomes. Consequently, reproductive health care is considered a principle constituent of comprehensive care for all patients with rheumatic ailments seen in the standard practice. Whilst pregnancy-associated complications have been reported in lupus, rheumatoid arthritis, and Sjogren’s syndrome, in some conditions such as lupus, antiphospholipid syndrome, inflammatory myopathies, and vasculitis, the pregnancy may accelerate the disease progression. Furthermore, the activity of some diseases such as lupus and antiphospholipid syndrome may be augmented by some contraceptive methods. Therapeutically, some patients are prescribed medications, such as methotrexate and mycophenolate which have potentially teratogenic effect. Therefore, to be able to help those patients, family planning should be patient-centred with decision-making tailored to the individual’s disease status. For those healthcare professionals interested in reproductive health care for their patients living with autoimmune rheumatic diseases, this review summarizes the available information in the literature and offers practical suggestions of patient-centred care in a dedicated rheumatology-led pregnancy clinic.