Rheumatic Disease & Reproductive Health

Updates from the ACR Convergence 2023 Review Course, part 7

SAN DIEGO—The pre-conference Review Course at ACR Convergence 2023, held Saturday, Nov. 11, and moderated by Noelle Rolle, MBBS, assistant professor in the Division of Rheumatology, associate program director of the Rheumatology Fellowship at the Medical College of Georgia, Augusta University, and Julia Schwartzmann-Morris, MD, associate professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y., tackled numerous important topics in rheumatology. Here, we report on the presentation by Megan Clowse, MD, MPH, associate professor of medicine and chief of the Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, N.C.

Dr. Clowse spoke on the subject of reproductive counseling for patients with rheumatic conditions, a topic that has been the focus of much of her research and scholarship.

Dr. Clowse

Risks & Pregnancy Termination

She began by explaining that rheumatic diseases can be associated with increased risks for both mother and baby, and include the increased risk of preterm delivery and pre-eclampsia seen in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis.

The incidence rate of induced abortions among women with SLE is about 17 per 1,000 person-years, a similar rate of induced abortions as in the general population.¹ Patients with SLE often have medical indications for this procedure. Many patients with SLE are exposed to teratogens, such as methotrexate or mycophenolate mofetil, and complicated pregnancies in which the health of the baby or mother are affected can have lasting consequences for patients.

In the U.S., pregnancy termination has historically been an option for women when there may be health consequences of continuing the pregnancy, but Dr. Clowse noted that the changing abortion laws in the wake of the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization in 2022 have limited accessibility of this procedure based on where a patient resides.^2,3

A Pregnancy Plan

Pregnancy planning often makes a significant difference in choosing the right time to conceive. However, real-world experience has shown that there is a wide range of planning for pregnancy seen in patients with rheumatic diseases, and unplanned pregnancies are not uncommon.

It’s important to consider whether an individual patient is medically and personally ready for pregnancy and to counsel patients on this subject, noted Dr. Clowse. Rheumatologists must be open and honest with patients in discussing preferences about if and when to conceive. Offering clear, concise, evidence-based information on the topic helps build trust.