![]() The Australian categorisation of drugs in pregnancy is an assessment of the risk of harm. Pregnancy should ideally be managed by a multidisciplinary team including obstetricians, obstetric medical physicians and rheumatologists. There are also specific maternal risks associated with the underlying disease. Poorly controlled disease is associated with adverse pregnancy outcomes such as miscarriages, pre-eclampsia, growth restriction and early delivery. Diseases with T helper type 1 phenotypes (rheumatoid arthritis) may improve with pregnancy while T helper type 2 phenotypes (such as systemic lupus erythematosus) may flare in pregnancy. There are physiological, hormonal and immunomodulatory changes during pregnancy. These diseases are likely to occur during the childbearing years. Many autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus are more frequent in women than in men. Many drugs are compatible with breastfeeding, but there are limited data on many of the new drugs. This increases the risk of relapse of many autoimmune diseases in particular rheumatoid arthritis, Crohn’s disease and autoimmune hepatitis. Postpartum, there is a sudden fall in hormone concentrations, and a switch to a pro-inflammatory state. Poorly controlled disease is associated with poor outcomes for both mother and fetus, such as higher risks of pre-eclampsia, early delivery and growth restriction of the fetus. Ideally, women should be on a stable regimen before conception. ![]() Pregnancy planning and counselling should be offered.Īutoimmune diseases such as rheumatoid arthritis tend to improve in pregnancy while systemic lupus erythematosus may increase in activity.ĭuring pregnancy the chosen regimen should control or prevent underlying disease activity and minimise risk to the fetus. It is associated with significant physiological, hormonal and immunomodulatory changes which are complex and vary according to the stage of pregnancy. Pregnancy presents challenges for women with autoimmune diseases. ![]()
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