Plan Ahead: Clinical Tips for Managing Reproductive Health in Patients with Rheumatic Disease

SINGAPORE—Most autoimmune diseases are more prevalent in women than men, and many female patients are of child-bearing age. Thus, it’s incumbent upon rheumatologists to discuss family planning with patients early and often.

At the 2024 Asia-Pacific League of Associations for Rheumatology (APLAR) Congress, May Ching Soh, MBChB, FRACP, head of the Department of Obstetric Medicine, Te Whatu Ora Counties Manukau, University of Auckland, New Zealand, gave an excellent lecture titled, Practical Tips for the Rheumatologist Dealing with Pregnant Patients.

Dr. Soh is both a rheumatologist and an obstetrician/gynecologist at the largest maternity unit in New Zealand. She has a wealth of experience in treating patients with rheumatic conditions, who often have multiple medical comorbidities.

Plan Ahead

Dr. Soh

Dr. Soh described why it’s important for rheumatologists to think about issues related to possible pregnancy in patients. These issues include the potential complex effects of autoimmune diseases and rheumatologic medications on the mother and fetus, the widely shared goal of helping patients plan for pregnancy when their disease is stable, the ever-present risk of disease flares during and after pregnancy, and the desire to care for patients holistically.

Dr. Soh said that one of the most joyous parts of her practice is helping a patient have a healthy and successful pregnancy as they seek to start or grow their family. She recommends discussing pregnancy planning with patients at the time of diagnosis because many rheumatic diseases affect fertility and pregnancy outcomes, as well as when medications are started or changing and when the patient’s disease is active.

Regarding medications used to treat rheumatic diseases, Dr. Soh noted that it’s important to avoid teratogenic medications during the first 12 weeks of pregnancy. This trimester is when clinical aspects of organogenesis of the fetus occur. Guidelines from major rheumatology organizations, such as the 2020 ACR guideline, can help steer providers in selecting or avoiding specific conventional, biologic and/or targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) based on their safety profiles in the context of pregnancy and breastfeeding.¹

Something rheumatologists may not know is that after 28 weeks’ gestation non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors should be avoided due to their associations with an increased risk of prenatal closure of the ductus arteriosus and the development of oligohydramnios.

Real-Life Scenarios

Dr. Soh highlighted several cases that illustrate the real-life management of reproductive issues in patients planning for conception or currently pregnant.