BALTIMORE—Understanding issues regarding pregnancy in women with rheumatic disease is important to patients and physicians alike, said Bonnie Bermas, MD, the Dr. Morris Ziff Distinguished Professor in Rheumatology at UT Southwestern Medical Center, Dallas, in her recent lecture at the Maryland Society for the Rheumatic Diseases.The physiologic changes in normal pregnancy, which include increased circulating plasma volume, hypercoagulability and an immunosuppressive state, reasonably prompt several questions in female patients with underlying autoimmune conditions. These topics of interest may include the impact of rheumatic disease on fertility, the likelihood of increased disease activity during pregnancy or poor pregnancy outcomes for baby or mother, and issues regarding which immunomodulating and immunosuppressant medications can safely be given in pregnancy.
Explore this issueNovember 2018
Pregnancy & RA
Dr. Bermas began by exploring these subjects in patients with rheumatoid arthritis (RA). Although RA patients tend to have smaller families and take a longer time to achieve pregnancy than those without the condition, there is no indication of compromise of ovarian reserve as measured by anti-Müllerian levels, indicating that some of these epidemiologic findings may be due to patient family planning choices driven by perceived rather than objective concerns about pregnancy.1
The scientific literature supports the classic teaching that RA appears less likely to flare during pregnancy, although more recent studies indicate that only 50–60% of women may experience disease remission in pregnancy rather than the higher rates quoted by Hench and others in the 1930s.2