Autoimmune and connective tissue disorders

Pregnant women with autoimmune rheumatic diseases, especially systemic lupus erythematosus (SLE) and systemic sclerosis, are at high risk of maternal disease flares, adverse fetal outcomes and potential drug teratogenic effects, making the management of these women particularly challenging. With improvements in diagnosis and treatment, however, these risks can be minimized by appropriate timing of pregnancy and optimization of therapy before conception. Preconception counseling represents a unique opportunity to optimize pregnancy outcome in women with chronic medical illnesses, those with autoimmune rheumatic diseases being no exception. This chapter reviews the impact of these diseases and their therapies on the mother and her fetus, the effect of pregnancy on these disorders with special emphasis on issues that should be discussed with women before they attempt to become pregnant, and measures that might be undertaken to optimize pregnancy outcome. The information provided can be used to counsel anxious mothers preconceptionally on what to expect during pregnancy and how to increase the likelihood of a successful pregnancy and the birth of a healthy infant.