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With a rheumatic disease, consult before a pregnancy

A rheumatic disease is no longer an obstacle to pregnancy as long as it is monitored. Experts insist on the importance of having a pre-conception consultation.

The pillars on which pregnancy must be supported in those patients with any rheumatic disease are, broadly speaking, the forecast and the Tracking.

Thus, it was pointed out during the 5th edition of the Fertile Age Course in Systemic Autoimmune Diseases (EAS) and Chronic Inflammatory Pathology, an initiative organized by the Spanish Society of Rheumatology (SER) with the collaboration of UCB pharmaceuticals.

And it is that in Spain, 1 in 4 people over 20 suffer from a rheumatic disease, and there is a greater prevalence among women. It is one of the most common musculoskeletal pathologies in young adults.

Many of the cases are diagnosed in the age range in which it begins to be considered formation of a familytherefore, inevitably, sexual and reproductive function and family planning are conditioned by this.

Is pregnancy safe with rheumatic disease?

Counseling prior to conception and the approach to pregnancy from different disciplines in women suffering from rheumatic diseases is essential to guarantee a safe pregnancy.

the doctor Sailing Dovespecialist of Rheumatology Service of the Doctor Balmis General University Hospital in Alicanteexplain the importance of planning and controlling pregnancy.

The progress of Medicine has made it possible for more patients with any rheumatic disease to have children, although it is necessary to monitor them.

“For example, active disease in patients with rheumatoid arthritis affects the newborn’s birth weight, which can have negative effects on the baby’s long-term health,” he warns.

The risks are present

All women with rheumatic pathologies are at greater risk of

  • premature birth. Compared with the general population, the probability of preterm birth among patients with rheumatic diseases is much higher.
  • Other factors. It is also associated with other complications. In the case of systemic lupus erythematosus and with antiphospholipid syndrome, the preeclampsia (high blood pressure and signs of liver or kidney damage in pregnant women) and the intrauterine growth problems.

In this sense, the doctor explains that it should not be a problem since it has been shown that monitoring certain biomarkers these complications can be detected early.

The latter, together with the use of certain therapies, favors the successful development of pregnancy and childbirth in patients with this type of pathology.

But one way or another, it places a special emphasis on monitoring the patient during her pregnancy:

“It is important to have the disease under control for at least 3 to 6 months before becoming pregnant, even twelve months in patients who have suffered severe outbreaks of some diseases, such as lupus.”

monitoring-pregnancy-rheumatic disease
EFE/Rafa Alcaide

Information as the key to the approach

The 25% of the Spanish adult population suffers from some rheumatic disease, being more frequent in women and appearing when they are young and considering motherhood. Precisely for this reason it is important to resolve any doubts that may arise in the situation.

“From the moment of their diagnosis, women of childbearing age must receive information about the management of their disease at this stage and receive adequate advice on contraceptives for those who do not wish to become pregnant”

Because it is important to understand the disease and how its treatment can affect fertility, pregnancy and lactation. The importance of work multidisciplinaryunderstood as the combination of rheumatology and obstetrics, it is a key piece for the care of the patient with rheumatic disease.

In this edition of the course, the focus is on treating patients with immune-mediated inflammatory diseases, such as rheumatoid and psoriatic arthritis, as well as autoimmune diseases such as lupus or antiphospholipid syndrome.

The coordinators of this SER initiative, doctors Julia Martínez, Juan Antonio Martínez and Andrea Pluma, insist on the importance of multidisciplinary management of women who wish to become pregnant and who suffer from this type of illness. But this follow-up must be prior to the pregnancy itself.

Nor are other factors to be taken into account neglected, as is the case of the mental health: the patients’ concern for the possibility of any complication is a particularly present reality, which is added in some cases to the fact that it is not possible to carry out a safe pregnancy at all stages of the disease.

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