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The Care and Management of Rheumatologic Disease in Pregnancy

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Medical Management of the Pregnant Patient

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Abstract

Rheumatologic diseases include inflammatory conditions such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), scleroderma, or vasculitis, which can complicate pregnancies. These autoimmune conditions may behave differently during pregnancy, such that RA commonly improves while SLE may flare. Active maternal disease is an independent risk factor for adverse pregnancy outcomes; thus, control of inflammation is imperative to ensure a successful pregnancy. This control may need to be achieved or maintained with immunosuppressive therapy. There is only uncertain safety data for certain immunosuppressive medications (e.g., biologic agents), while others are clearly with teratogenic risk (e.g., methotrexate, leflunomide, cyclophosphamide). Increasing comfort with medications deemed relatively safe during pregnancy (e.g., azathioprine, hydroxychloroquine, prednisone) may facilitate their use in appropriate situations and afford the necessary control of inflammatory disease. Preconception counseling is essential for every female with childbearing potential who has inflammatory conditions. Multidisciplinary management of the pregnant patient with autoimmune disease is always ideal for their care.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, UCSF Fresno, 2335 East Kashian Lane, Suite 301, Fresno, CA, 93701, USA

    Candice Yuvienco M.D.

  2. University Rheumatology Associates, 2335 East Kashian Lane, East Medical Plaza Suite 301, Fresno, CA, 93701, USA

    Candice Yuvienco M.D.

  3. Obstetric Medicine, Rheumatology, Women’s Medicine Collaborative, The Miriam Hospital, Providence, RI, 02904, USA

    Kerri Batra M.D.

  4. The Warren Alpert Medical School of Brown University, Providence, RI, 02904, USA

    Kerri Batra M.D.

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  1. Candice Yuvienco M.D.
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  2. Kerri Batra M.D.
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Correspondence to Candice Yuvienco M.D. .

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Editors and Affiliations

  1. SVP Women’s Services and Clinical Integration, Lifespan Corporation, Professor and Vice Chair of Medicine Director of Obstetric Medicine, Alpert Medical School at Brown University, Providence, Rhode Island, USA

    Karen Rosene-Montella

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Yuvienco, C., Batra, K. (2015). The Care and Management of Rheumatologic Disease in Pregnancy. In: Rosene-Montella, K. (eds) Medical Management of the Pregnant Patient. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1244-1_13

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