Stratifying management of rheumatic disease for pregnancy and breastfeeding

The management of inflammatory rheumatic diseases during pregnancy and breastfeeding has undergone considerable change in the past few years. Modern therapeutics, including biologic and targeted synthetic DMARDs, have enabled substantial improvements in the control of rheumatic diseases, resulting in more patients with severe disease considering pregnancy. Therefore, management of disease for these patients needs to be discussed with clinicians before, during and after pregnancy and patients need to know what complications they might experience before they become pregnant. This Review summarizes the effects pregnancy has on various rheumatic diseases and the effects these diseases have on pregnancy, as well as providing advice regarding the alteration and monitoring of therapy before, during and after pregnancy. Pregnancy can affect the underlying disease and vice versa, and drug therapy may need to be altered before, during and after pregnancy. With careful planning, monitoring and treatment, most women with inflammatory rheumatic diseases can have successful pregnancies.