Vol 92, No 9 (2021)
Review paper
Published online: 2021-08-23

open access

Page views 892
Article views/downloads 618
Get Citation

Connect on Social Media

Connect on Social Media

Inflammatory rheumatic diseases and pregnancy

Katarzyna Klimaszyk1, Ewa Wender-Ozegowska1, Malgorzata Kedzia1
Pubmed: 34541654
Ginekol Pol 2021;92(9):663-667.


Pregnancy in a patient diagnosed with systemic connective tissue disorder is a challenge that requires a close co-operation between a rheumatologist and gynaecologist. Good control over the activity of the underlying condition and the choice of appropriate time for planning a pregnancy have direct effect on the pregnancy results in these patients. Applying gynaecological supervision adequate to the increased risk of complications is also very important.
The aim of this study is to present the current knowledge on the care over pregnant patients with systemic connective tissue diseases and to draw attention to the importance of pregnancy planning in this group of patients.

Article available in PDF format

View PDF Download PDF file


  1. Sangha O. Epidemiology of rheumatic diseases. Rheumatology (Oxford). 2000; 39 Suppl 2: 3–12.
  2. Østensen M, Andreoli L, Brucato A, et al. State of the art: Reproduction and pregnancy in rheumatic diseases. Autoimmun Rev. 2015; 14(5): 376–386.
  3. Bharti B, Lee SJ, Lindsay SP, et al. Disease Severity and Pregnancy Outcomes in Women with Rheumatoid Arthritis: Results from the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project. J Rheumatol. 2015; 42(8): 1376–1382.
  4. de Man YA, Hazes JMW, van der Heide H, et al. Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum. 2009; 60(11): 3196–3206.
  5. Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Annals of the Rheumatic Diseases. 2016; 76(3): 476–485.
  6. Cortés-Hernández J, Ordi-Ros J, Paredes F, et al. Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: a prospective study of 103 pregnancies. Rheumatology (Oxford). 2002; 41(6): 643–650.
  7. Clowse MEB, Magder L, Witter F, et al. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum. 2006; 54(11): 3640–3647.
  8. Eudy AM, Siega-Riz AM, Engel SM, et al. Effect of pregnancy on disease flares in patients with systemic lupus erythematosus. Ann Rheum Dis. 2018; 77(6): 855–860.
  9. Götestam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016; 75(5): 795–810.
  10. Coscia LA, Armenti DP, King RW, et al. Update on the Teratogenicity of Maternal Mycophenolate Mofetil. J Pediatr Genet. 2015; 4(2): 42–55.
  11. Leroy C, Rigot JM, Leroy M, et al. Immunosuppressive drugs and fertility. Orphanet J Rare Dis. 2015; 10: 136.
  12. Youngstein T, Hoffmann P, Gül A, et al. International multi-centre study of pregnancy outcomes with interleukin-1 inhibitors. Rheumatology (Oxford). 2017; 56(12): 2102–2108.
  13. Giles I, Yee CS, Gordon C. Stratifying management of rheumatic disease for pregnancy and breastfeeding. Nat Rev Rheumatol. 2019; 15(7): 391–402.
  14. Kallur SD, Patil Ba, Reddy P, et al. P. K. Organ dysfunction and organ failure as predictors of outcomes of severe maternal morbidity in an obstetric intensive care unit. J Clin Diagn Res. 2014; 8: OC06–OC08.
  15. Franceschini F, Cavazzana I. Anti-Ro/SSA and La/SSB antibodies. Autoimmunity. 2005; 38(1): 55–63.
  16. Simister NE, Story CM, Chen HL, et al. An IgG-transporting Fc receptor expressed in the syncytiotrophoblast of human placenta. Eur J Immunol. 1996; 26(7): 1527–1531.
  17. Costedoat-Chalumeau N, Amoura Z, Lupoglazoff JM, et al. Outcome of pregnancies in patients with anti-SSA/Ro antibodies: a study of 165 pregnancies, with special focus on electrocardiographic variations in the children and comparison with a control group. Arthritis Rheum. 2004; 50(10): 3187–3194.
  18. Clowse MEB, Eudy AM, Kiernan E, et al. The prevention, screening and treatment of congenital heart block from neonatal lupus: a survey of provider practices. Rheumatology (Oxford). 2018; 57(suppl_5): v9–vv17.
  19. Izmirly PM, Costedoat-Chalumeau N, Pisoni CN, et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation. 2012; 126(1): 76–82.
  20. Izmirly PM, Kim MY, Llanos C, et al. Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-associated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquine. Ann Rheum Dis. 2010; 69(10): 1827–1830.
  21. Martínez-Sánchez N, Pérez-Pinto S, Robles-Marhuenda Á, et al. Obstetric and perinatal outcome in anti-Ro/SSA-positive pregnant women: a prospective cohort study. Immunol Res. 2017; 65(2): 487–494.
  22. Zuppa AA, Riccardi R, Frezza S, et al. Neonatal lupus: Follow-up in infants with anti-SSA/Ro antibodies and review of the literature. Autoimmun Rev. 2017; 16(4): 427–432.
  23. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006; 4(2): 295–306.
  24. Wahl DG, Guillemin F, de Maistre E, et al. Risk for venous thrombosis related to antiphospholipid antibodies in systemic lupus erythematosus--a meta-analysis. Lupus. 1997; 6(5): 467–473.
  25. Lin HC, Chen SF, Lin HC, et al. Increased risk of adverse pregnancy outcomes in women with rheumatoid arthritis: a nationwide population-based study. Ann Rheum Dis. 2010; 69(4): 715–717.
  26. Skomsvoll JF, Ostensen M, Irgens LM, et al. Obstetrical and neonatal outcome in pregnant patients with rheumatic disease. Scand J Rheumatol Suppl. 1998; 107: 109–112.
  27. Wolfberg AJ, Lee-Parritz A, Peller AJ, et al. Association of rheumatologic disease with preeclampsia. Obstet Gynecol. 2004; 103(6): 1190–1193.
  28. Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: A meta-analysis of studies published between years 2001-2016. J Autoimmun. 2017; 79: 17–27.
  29. Henderson JT, Whitlock EP, O'Connor E, et al. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014; 160(10): 695–703.
  30. Bramham K, Hunt BJ, Bewley S, et al. Pregnancy outcomes in systemic lupus erythematosus with and without previous nephritis. J Rheumatol. 2011; 38(9): 1906–1913.
  31. Espinoza J, Kusanovic JP, Bahado-Singh R, et al. Should bilateral uterine artery notching be used in the risk assessment for preeclampsia, small-for-gestational-age, and gestational hypertension? J Ultrasound Med. 2010; 29(7): 1103–1115.
  32. Soh MC, Nelson-Piercy C, Soh MC, et al. High-risk pregnancy and the rheumatologist. Rheumatology (Oxford). 2015; 54(4): 572–587.
  33. Fouda UM, Sayed AM, Abdou AMA, et al. Enoxaparin versus unfractionated heparin in the management of recurrent abortion secondary to antiphospholipid syndrome. Int J Gynaecol Obstet. 2011; 112(3): 211–215.
  34. Hamela-Olkowska A, Dangel J. Ocena czasu przewodzenia przedsionkowo-komorowego metodą Dopplera pulsacyjnego u zdrowych płodów. Ginekol Pol. 2009; 80: 584–589.