Rheumatologists Can Guide Patients During Pregnancy, Family Planning

Otherwise, patients are most likely guided by information given by the doctors they see more often, such as general practitioners or pediatricians.

Guiding Health Pre-Pregnancy

Another area discussed during the episode is medication choices made before a woman becomes pregnant. Speakers addressed research from Bortoluzzi et al., which was published in 2021 in Arthritis Care & Research.⁴ This topic is a key area because of the increased risk of adverse pregnancy outcomes when a patient’s disease is very active. Changing medications if needed to aim for quiet disease is often more useful before pregnancy than trying to do it after a woman is pregnant, Dr. Sammaritano says.

Quiet disease can help lead to better outcomes for both the mother and the baby. This approach applies to both lupus and RA, Dr. Sammaritano says.

This finding increases the importance of rheumatologists discussing family planning with all their patients early because certain medications can be started before the patient gets pregnant.

“Everything we give our patients impacts this area, and we need to be involved from the beginning,” Dr. Sammaritano says. This includes ensuring patients are using contraception if they take medications that are not considered safe during pregnancy.

Dr. White says she has been fortunate to have a rheumatologist who regularly addressed this topic during her pregnancies. It’s also important to address these concerns with male patients of reproductive age, she adds, including reviewing which medications they can use safely if they are trying to father a child.

References

1. Sammaritano LR, Bermas BL, Chakravarty EL, Chambers C, Clowse MEB, Lockshin MD, et al. 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol. 2020 Apr;72(4):529–556.
2. Talabi MB, Eudy AM, Jayasundara MJ, et al. Tough choices: Exploring medication decision-making during pregnancy and lactation among women with inflammatory arthritis. ACR Open Rheumatol. 2021 Jul;3(7):475–483.
3. Mills BS, Bermas BL. Improving knowledge of lactation compatibility of antirheumatic medications among providers who care for patients with rheumatic disease. ACR Open Rheumatol. 2021 Jan;3(1):50–54.
4. Bortoluzzi A, Andreoli L, Carrara G, et al. Improved pregnancy outcomes in patients with rheumatoid arthritis who followed an ideal clinical pathway. Arthritis Care Res (Hoboken). 2021 Feb;73(2):166–172.