Unfortunately a number of woman do suffer from chronic illnesses and many of them fall in the spectrum of what we call rheumatic disorders.
This group of disorders will include both serious and relatively minor illnesses but potentially all of these may have an impact on both the pregnancy, the health of the mother and the health of the unborn child.
It is not my intention to focus specifically on each and every rheumatic disorder that may be encountered but to try and present some general guidelines that would hopefully help to mitigate against adverse outcomes for both mother and the child.
It is not the aim of this page to provide absolute guidelines, there certainly are not absolute guidelines available but my aim is to try and ensure that the whole process of planning a child, conception, the pregnancy, delivery and outcomes after delivery are anticipated planned and discussed with your health care provider.
I would like to suggest that the most important consideration for any patient suffering from rheumatic disorder is to keep in contact with her health care provider from the time of planning a pregnancy right the way through the pregnancy and beyond.
The introduction of a whole new era of medications available to treat rheumatic disorders, higher standards of living, better prenatal care and better monitoring of the pregnancy as well as highly specialized units aimed specifically at managing these high risk pregnancies have had a major impact over the past few decades and increased dramatically the chances of successful conception and a successful pregnancy.
It would be exceptionally rare for a woman ever to be advised against pregnancy mainly because she suffers from rheumatic disorder but there are a number of very simple guidelines that all expectant mothers must be aware of.
First and foremost is to discuss your plans with your healthcare provider both your family doctor as well as your rheumatologist, well in advance of planned pregnancies. There is no question that having a rheumatic disorder well controlled prior to planned conception is perhaps one of the most important predictors of a successful outcome. Patients who may be suffering from, for example, rheumatoid arthritis and have very unstable disease with a lots of inflammation in the joints, those were not feeling well or in pain have a higher complication rate. Patients who have disorders such as systemic lupus erythematosus likewise must be well controlled hopefully without any evidence of any organ involvement particularly kidney, heart or lung prior to planning conception.
It is for this reason that adhering to treatment protocols that are discussed with you by your healthcare providers are just so important.
Maintaining a healthy lifestyle is fairly obvious but being compliant with the guidelines and the advice given to you both in terms of drug therapy, attending regular clinic visits is just so important.
With regard specifically to rheumatoid arthritis, years ago and number of the drugs that we used had to be stopped prior to conception and many ladies had to conduct the pregnancy without any form of drug therapy. Now it is generally believed and probably in most cases true, the symptoms during pregnancy particularly with regard to joint inflammation and pain may improve but there is still a lot of evidence to suggest that there may be slow ongoing damage to joints mainly as a consequence of an ongoing inflammatory response that is not always detectable and the mother often feels well.
Not all ladies are this fortunate there are number of woman who go through pregnancy with evidence of ongoing inflammation, joint discomfort and progressive damage to the joints and could not be satisfactorily treated due to the potential side effects of some of the drugs. That fortunately has changed, better scientific studies of the mechanisms of actions of drugs that we used in the past has shown that a number of drugs may be safely used in pregnancy with certain guidelines and there is a new class of drugs, the biologic medications, a number of which may actually be used throughout pregnancy in order to try and minimize damage to the mother and these drugs do not have a risk of causing damage to the unborn child.
Other therapeutic armamentarium with disorders such as systemic lupus erythematosus is not as encouraging however patients who are in remission with regard to the symptoms and do not have any evidence of involvement of organ systems may well conduct a very normal pregnancy but obviously need to be monitored.
It is therefore my plea and my request that any woman with a rheumatic disorder planning conception discuss this well in advance with her health care provider and rheumatologist in order to try and make a plan to ensure that the disorders as well controlled as possible prior to conception and to ensure that you keep in touch throughout your pregnancy with your healthcare providers, you will be in contact with specialized units including rheumatologists, OB/GYN specialists, midwives, paediatricians and facilities that are geared towards caring for patients with these high risk pregnancies.