Management of pregnancy in patients with rheumatic diseases: modern therapeutic options

Rheumatic diseases such as systemic lupus erythematosus and rheumatoid arthritis frequently begin in reproductive age, resulting in a high incidence of autoimmune disorders during pregnancy. Managing these patients is challenging, necessitating a balance between effective control of rheumatic disease activity for a favorable pregnancy outcome and minimizing risks to the fetus.

This paper summarizes modern approaches to preconception care, pregnancy management, safe therapy selection, and monitoring of complications in patients with rheumatic diseases, primarily systemic lupus erythematosus and rheumatoid arthritis. The paper reviews relevant guidelines, including the updated 2024 EULAR, data from national and international registries, and findings of cohort and retrospective studies on pregnancy outcomes in patients with rheumatic diseases.

Rheumatic disease activity during conception and gestation is a key predictor of adverse outcomes such as pre-eclampsia, fetal growth retardation, preterm delivery, and congenital abnormalities. Achieving sustained remission 6–12 months before pregnancy considerably increases the likelihood of having a healthy child. The therapeutic strategy is based on the personalized selection of drugs that are suitable for pregnancy and lactation. Hydroxychloroquine is essential for the treatment of systemic lupus erythematosus owing to its immunomodulatory and antithrombotic properties, established safety profile, and positive impact on outcomes. Tumor necrosis factor inhibitors can be used in rheumatoid arthritis until late pregnancy or in patients with high disease activity. Methotrexate, mycophenolate mofetil, and cyclophosphamide are strictly contraindicated during pregnancy and must be discontinued at the planning stage. Effective disease control requires multidisciplinary collaboration between a rheumatologist and an obstetrician-gynecologist at all stages, from preconception counseling and follow-up during pregnancy to postpartum care.

Thus, favorable pregnancy outcomes in patients with rheumatic diseases are possible with careful pregnancy planning when in remission, safe and effective maintenance therapy, and continuous multidisciplinary monitoring. Adherence to these principles reduces risks for both mother and fetus.