#2-82E. Navigating Rheumatic Disease in Pregnancy: Introducing the Four Ds Framework (Rheum, 2025)

How should clinicians systematically approach the complex discussions surrounding pregnancy planning for patients with Inflammatory Rheumatic Diseases (IRDs)? This editorial introduces a simple, vital framework—the "Four Ds"—to guide consultations for individuals with IRDs considering pregnancy. The Ds stand for Discuss, Disease (features), Damage (organ damage), and Drugs, aiming to optimize outcomes throughout the reproductive journey, including the often-overlooked postpartum period. The core insight is the proposal of this framework as a structured tool to ensure disease quiescence is achieved on pregnancy-compatible medication, thereby minimizing the elevated risks of adverse maternal and fetal outcomes associated with active disease. The authors emphasize that early and regular family planning conversations (Discuss) are crucial, as lack of planning increases adverse outcomes. However, it is essential to remember that this article is an editorial based on references to existing research, not an original study validating a specific intervention. This framework is highly relevant for rheumatologists and obstetricians, providing a systematic approach to pre-conception counselling, ensuring critical factors like assessing organ dysfunction (Damage) and reviewing teratogenic drugs are addressed, ultimately optimizing patient care.

Citation: Goulden B, Giles I. The four Ds—the four things that matter most to ensure rheumatic disease control in pregnancy and beyond. Rheumatology. 2025. DOI: 10.1093/rheumatology/keaf443

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