#2-97E. Navigating Reproductive Health in Autoimmune Rheumatic Diseases (Autoimmun Rev, 2023)

How do you balance effective disease control with fetal safety when treating pregnant patients with active SLE or RA? This episode explores a comprehensive review derived from the 11th International Conference on Reproduction, Pregnancy and Rheumatic Diseases. The paper synthesizes critical updates on risk stratification, the impact of COVID-19 on fertility, and the management of assisted reproduction in autoimmune rheumatic diseases (ARD). The most pivotal clinical takeaway is the solidifying evidence supporting the use of TNF inhibitors to maintain disease remission during pregnancy, contrasting sharply with the recommendation to avoid small molecules, such as JAK inhibitors, due to potential teratogenicity and insufficient safety data. However, when critically appraising these findings, listeners must note that much of the evidence regarding newer biologics and COVID-19 outcomes relies on observational registry data with limited sample sizes rather than large-scale randomized trials. This review is vital for clinicians to confidently counsel patients, ensuring that the significant risks of untreated maternal disease are weighed effectively against medication exposure to optimize outcomes for both mother and child.

Citation: ANDREOLI, L. et al. Immunology of pregnancy and reproductive health in autoimmune rheumatic diseases. Update from the 11th International Conference on Reproduction, Pregnancy and Rheumatic Diseases. Autoimmunity Reviews. 2023. DOI: 10.1016/j.autrev.2022.103259

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.