6 frequently asked questions about rheumatic diseases and pregnancy

Rheumatic diseases encompass many pathologies that affect the fertile age, so a good planning of pregnancy and a good control of it depend to a great extent on whether it is successful and the couple can enjoy their child at the end of it.

Is pregnancy with a rheumatic disease possible?

None of the rheumatic or autoimmune diseases absolutely contraindicate pregnancy. The decision is always up to the patient, although she should be aware of the risks and agree with the rheumatologist on the best time to do so.

There are rheumatic diseases that affect conception, there are others that are associated with a decrease in fertility due to sperm impairment, and others that increase the number of miscarriages or fetal losses. In addition, some of the treatments used may cause malformations in the fetus. It should also be taken into account that pregnancy may aggravate some of these diseases.

When is the best time to conceive if you have a rheumatic disease?

Regardless of the rheumatic disease you have, the best time is when the disease is under control. If possible, the disease should be in remission, that is, under absolute control, but this is not always possible and therefore at least the minimum possible activity is sought.

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Although this should be agreed with the rheumatologist, the ideal time in mild or moderate disease is when the disease is in remission for at least three months and, if the disease is severe, six months.

Who should follow up a pregnancy with rheumatic diseases?

For a good follow-up of the case, it is recommended to resort to multidisciplinary units with at least one specialist in Gynecology and another in Rheumatology. In general, monthly visits are recommended, although it depends on the disease and its severity. Likewise, analytical controls specific to pregnancy and rheumatic disease should be performed, without forgetting that pregnancy itself alters the normal values without meaning that a flare-up is occurring.

Should rheumatic disease medication be suspended in order to conceive?

In no case should the medication be suspended without consulting the regular rheumatologist, as this may cause a worsening of the disease that hinders or prevents conception.

Even so, as explained above, there are medications that should be discontinued prior to conception, as they may affect the fetus.

What happens if it is the father who has the rheumatic disease?

Rheumatic diseases do not cause sterility, but there are some pharmacological treatments that, if taken by men, can affect the future fetus, causing malformations. For this reason, even in the case of men who are planning to become fathers, it is necessary to plan it with their rheumatologist, modifying the treatment to another that is not harmful to the pregnancy until the moment of conception.

What are the main rheumatic diseases that affect pregnancy?

There are several rheumatic diseases that can affect pregnancy, of which the main ones are:

  • Systemic lupus erythematosus (SLE): this is a disease of the immune system that can affect virtually any organ and also affect conception and pregnancy. On the other hand, pregnancy can cause a worsening of the disease, especially in patients who have already had complications in previous pregnancies or who have moderate-severe renal involvement.
  • Antiphospholipid syndrome: during pregnancy, it can cause consequences such as fetal loss of more than a few weeks without morphological alterations, loss of three embryos before one week of gestation or premature delivery before 34 weeks due to preeclampsia, eclampsia or placental insufficiency.
  • Neonatal lupus: anti-Ro/La antibodies can appear in association with multiple autoimmune diseases and also in people who do not suffer from any of them. They are very important in pregnancy, as they are responsible for fetal pathology and neonatal lupus.
  • Rheumatoid arthritis, ankylosing spondylitis and spondyloarthropathies: during pregnancy, in many cases there is an improvement of the symptoms but with a resurgence after delivery. In all these diseases it is very important to control the disease in advance and to avoid the use of drugs that are dangerous for the fetus, waiting the necessary time for the cleansing of the organism before pregnancy.