Rheumatologists don’t have clear-cut, defined guidelines for managing patients with rheumatic disease during pregnancy, but that dearth of research and information won’t last, according to one of the U.S.’s leading voices on the topic.
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“We are getting better [information and guidelines] … and the more resources clinicians have, the easier it will be for us to talk to our rheumatology patients about family planning and pregnancy,” says Bonnie Lee Bermas, MD, a veteran rheumatologist and director of the Clinical Lupus Center at Brigham and Women’s Hospital in Boston.
She notes some recent efforts to address the knowledge gaps, including the 2015 ACR Reproductive Health Summit and a new guideline from the British Society for Rheumatology. “The ACR recognizes that this is important. Everyone recognizes this is an unmet need,” she says.
Dr. Bermas has collaborated with OB/GYNs for more than two decades and, in 2010, helped develop an interdisciplinary program between rheumatology and OB-GYN at Brigham and Women’s Hospital.
She took a few moments to speak with The Rheumatologist on the subject.
Question: What is the latest update on pregnancy and rheumatic disease?
Answer: I think that we have traditionally erred on the side of under-treating patients with rheumatic diseases during pregnancy because we have always been concerned about the safety of our medications during pregnancy and how they impact the developing fetus. I think that we are starting to understand that under-treating disease carries its own risk [because] disease activity itself can have a negative impact on pregnancy.
Q: What, specifically, needs more research?
A: First, we need better information on drug safety during pregnancy. We are currently limited in our knowledge regarding drug safety by lack of clinical trial data in pregnant women and an incomplete understanding of drug metabolism and placental transfer to inform product labeling. Second, we need to understand how both medication use and disease activity during pregnancy impact long-term outcomes for children.
Q: What is the most important take-home message for rheumatologists?
A: Discuss family planning with your patients, because timing a pregnancy when disease is under control is essential to a successful outcome for mother and baby. Make sure to transition patients to medications compatible with pregnancy in advance of conception. If possible, find a team of maternal fetal medicine specialists who you feel comfortable working with.
Richard Quinn is a freelance writer based in New Jersey.