For many aspiring mothers with autoimmune disease, pregnancy can be daunting and full of unknowns. In some cases, those suffering from specific autoimmune conditions have chosen to forego pregnancy altogether due to concerns about their disease treatments and adverse pregnancy outcomes.
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Fertility and Rheumatoid Onset
MedPage Today
British women whose capability of bearing children either started late or ended early -- naturally or otherwise -- were at increased risk for developing rheumatoid arthritis (RA), compared with women with earlier menarche or later menopause, researchers found.
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This week I reached out to many leaders in rheumatology and asked: who are the great women in rheumatology who should be recognized? This was prompted by a smart article in Annals of Rheumatic Disease written by Drs. Tuhina Neogi (Boston) and Nicola Dalbeth (N. Zealand), entitled "Where are the women ‘Heroes and Pillars of Rheumatology’?
Nouf Al hemmadi
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Very insightful talk on Vasculitis and pregnancy by Catherine Sims.
Pregnancy compatible medications.
Remission state.
Checking antibodies ; risk of transmission, pregnancy and fetal morbidity.
#RNL2024
@RheumNow https://t.co/81NAN1ulO5
@drcassysims recommends @NIH resource: https://t.co/ebtvc2zYbE to guide lactation- updated and run by pharmacists. #RNL2024 @rheumnow
Nipple Raynaud's is an issue for some women with rheumatic diseases that occurs during breastfeeding and can be very painful @DrCassySims #RNL2024 @rheumnow
https://t.co/HbaRpUnEBF
Eric Dein
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High risk medications for pregnancy:
MTX- 40% pregnancy loss, 6-10% birth defects
MMF/CYC - 40% pregnancy loss, 25% birth defects
Recommend 2 forms contraception on MMF
Change meds slowly to safe Rx and monitor disease activity at least 3 mos before pregnancy
#RNL2024 @RheumNow
@DrCassySims noted if pts get accidentally pregnant on Methotrexate, stop med and give high dose folic acid 5 mg/d and alert high risk OB/MFM #RNL2024 @RheumNow #ReproductiveRheum https://t.co/DFiwaTiHVf
We can do our best to optimize them for the best possible pregnancy outcomes?
1. Confirm pregnancy goals/timeline
2. Discuss patient’s disease activity over the past 12 mo
3. Document end organ damage and the last time this was assessed
4. Review medications
5. Check… https://t.co/7xQsGW9dKa
Richard Conway
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Rheumatology drugs in pregnancy. Just missing leflunomide in that big no no section @DrCassySims @RheumNow #RNL2024 https://t.co/ZPtTGRqPki
@DrCassySims: the Pregnancy Checklist for #Vasculitis patients @rheumnow #RNL2024 #ReproductiveRheumatology
👉confirm pregnancy goals
👉review meds, dz activity in the last 12 months
👉document end organ damage
👉assess Ro/La
👉discuss role of ASA
👉work w/ MFM/subspecialists https://t.co/5z4XeMRzGI
Eric Dein
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Pregnancy in vasculitis checklist:
- goals and timeline
- disease activity in 12 mos
- is there end organ damage?
- Review Rx
- h/o clots/miscarriages, APLS?
- Check Ro/La
- Role for ASA?
- Refer to MFM
Catherine Sims #RNL2024 @RheumNow
Eric Dein
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How do vasculitis pts do during pregnancy?
Variable due to different diagnoses of flares
Gatto 2012: TA 3% flare, GPA 45% flare
Fredi 2015: 35% flare
Nguyen 2021: LVV 25% flare, 36% SVV
-Catherine Sims
#RNL2024 @RheumNow
Dr. A. Armstrong's Key Takeaways for PsO.
TNFi - great in PsA and pregnancy
IL-17i - robust PsO efficacy and in PsA
IL-23i - robust in PsO, fewer injections, and efficacious in PsA.
#RNL2024 @RheumNow @_AprilArmstrong https://t.co/j8LaOGITuf
QD Clinic - Suspend MTX How Long?
Pregnancy and MTX - how long do you have to be off?
https://t.co/pTz8nlHpWN https://t.co/YrG7cKgbvF
Bidirectional relationship betw Autoimmune disease (AD) & perinatal depression (PND); 1:10 case control study of 1.3 milion pregnancies & 55,299 incident PND found AD preg w/ a 30% (OR 1.3) higher risk of PND & PND had a 30% ^ risk (OR 1.3) of AD https://t.co/zkwIo6liC7 https://t.co/Sy1HPLLeva


