High-risk pregnancy and the rheumatologist

Rheumatology (Oxford). 2015 Apr;54(4):572-87. doi: 10.1093/rheumatology/keu394. Epub 2014 Dec 3.


Rheumatologists are increasingly involved in the care of young women who, in the age of biologic therapy, are now gaining control of their rheumatic diseases and attempting pregnancy. With careful planning, most women with rheumatic diseases have successful pregnancies. This article focuses specifically on the highest-risk pregnancies and controversial areas. We discuss the women at risk of complications, the types of maternal and fetal complications, the treatments that can be used in pregnancy (and breastfeeding) and longer-term outcomes that could affect the mother. SLE, RA, ANCA-associated vasculitides, large vessel vasculitis (e.g. Takayasu's) and other CTDs (e.g. scleroderma) are among the conditions covered. The evidence and controversies regarding the recommendations for the use of biologics in pregnancy are discussed. The role of the rheumatologist in pregnancy planning and caring for the pregnant and post-partum woman as part of the multidisciplinary team is discussed.

Keywords: anti-phospholipid antibodies; biologics; connective tissue diseases; pregnancy complications; vasculitis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / therapy
  • Arthritis, Rheumatoid / therapy*
  • Breast Feeding
  • Connective Tissue Diseases / therapy*
  • Disease Management
  • Female
  • Humans
  • Lupus Erythematosus, Systemic / therapy
  • Pregnancy
  • Pregnancy Complications / therapy*
  • Pregnancy, High-Risk*
  • Scleroderma, Systemic / therapy
  • Takayasu Arteritis / therapy
  • Vasculitis / therapy*