Pregnancy management in women with
Rheumatic and Musculoskeletal Disease
(Part 2)
This week, we continue with our discussion on managing the pregnancy of women with rheumatic and musculoskeletal disease (RMD).
In women with RMD who are presently on the family way, and who suffer from an active disease, experts recommend initiating or continuing a pregnancy-compatible steroid-sparing medication.
It is best to understand that both active RMD and continuous high-dose glucocorticoid treatment have the potential to cause harm to the mother and the fetus. Hence, laboratory testing in pre-pregnancy or early pregnancy for important autoantibodies is a must.
Finding out anti-Ro/(Sjogren’s syndrome A) SSA, anti-La/(Sjogren’s syndrome B) SSB, and antiphospholipid antibodies (aPL) status improves the management of health in relation with pregnancy and help manage potential harm to the fetus.
Experts strongly recommend testing for anti-Ro/SSA and anti-La/SSB at least once prior or during the early part in pregnancy in women with systemic lupus erymatosus (SLE) or SLE-like disorders, Sjögren’s syndrome, systemic sclerosis, and rheumatoid arthritis.
Due to the relative persistence and unchanged titers of these antibodies, experts highly recommend against any repeat testing for anti-Ro/SSA and anti-Ro/SSB during a woman’s pregnancy.
The management of the health of pregnant women with RMD focuses primarily on the presence of underlying SLE or positive aPL.
One aspect of disease in systemic sclerosis that needs to get some focus is the development of scleroderma renal crisis.
Effective drugs are usually contraindicated during pregnancy because of the potential adverse effects to the fetus, however, these drugs need to be considered in this circumstance.
Experts recommend the use of angiotensin-converting enzyme inhibitor or angiotensin receptor blockade therapy to treat active scleroderma renal crisis during pregnancy, due to the risk of possible death of the mother or the fetus.
Untreated disease is a greater risk to women with RMD and are pregnant than the risk of the use of these medications. It is a fact that scleroderma renal crisis is rare in pregnancy, and it can easily be confused with preeclampsia.
Angiotensin-converting enzyme inhibitors can help with protecting the kidneys and life saving but can be contraindicated in the second and third trimesters of pregnancy due to the potential oligohydramnios or permanent damage to the fetus’ kidneys.
This treatment should be only used as an option for active scleroderma renal crisis.
We shall continue with our discussion on pregnancy management of women with RMD in next week’s column.