Therapeutic challenges in the treatment of systemic inflammatory disease in pregnancy

Obstet Med. 2019 Dec;12(4):180-185. doi: 10.1177/1753495X18819929. Epub 2019 Jan 9.


Background: Granulomatosis with polyangiitis and Behçet's disease can occur during pregnancy and may be treated by ophthalmologists, rheumatologists, and obstetricians. We hypothesized that specialty training would affect the way physicians selected therapy.

Methods: Using an online questionnaire, 209 uveitis specialists, 853 rheumatologists, and 2500 obstetricians were surveyed. Respondents were given clinical vignettes containing a female patient who was contemplating pregnancy or in the first trimester and was diagnosed with granulomatosis with polyangiitis or Behçet's disease.

Results: In the patient with granulomatosis with polyangiitis, therapy choice between specialties for biologic versus non-biologic systemic immunosuppressive medications was significantly different for both the non-pregnant and pregnant patient (p < 0.00001, p < 0.00003). In the non-pregnant patient diagnosed with Behçet's disease, the therapy choice between biologic versus non-biologic medications was also significantly different (p < 0.0003).

Conclusions: Specialty training affects how physicians manage granulomatosis with polyangiitis and Behçet's disease. Development of inter-specialty guidelines and treatment plans may improve outcomes, communication, and patient care.

Keywords: Behçet’s disease; Granulomatosis with polyangiitis; immunosuppression; pregnancy.