Practical management of the pregnant patient with rheumatic disease

Rheumatic and autoimmune diseases are often present in women during the childbearing years and as such, correct management of pregnancy throughout its course is of significance to all those affected. Previously women with systemic rheumatic diseases were counselled against pregnancy as the majority of medications carried potential or perceived teratogenic risk. But in recent years new therapies have emerged that have advanced treatment. Patients have experienced significant improvements in physical function, quality of life, and reduced damage accrual. As a result, an expanded cadre of health care providers now need to be able to manage pregnancy in women with underlying rheumatic disease, both in acute or chronic settings. Practical Management of the Pregnant Patient with Rheumatic Disease is a quick-access guide of the most up-to-date understanding of the interplay between pregnancy and rheumatic diseases and principles of management before, during and after pregnancy assisting in decision making regarding treatment of women with autoimmune diseases. This collection of 70 cases covers pregnancy counseling, the management of disease flares, thromboembolic disease, the management of patients with end organ disease, advice on medications, obstetric complications, infections and the management of rare diseases in women with rheumatic diseases before and during pregnancy and post-partum. The handbook provides concise recommendations for all providers who may encounter women of child-bearing age including rheumatologists, gynaecologists, paediatricians, primary care providers and health professionals dealing with pre-conceptional and pregnant women with rheumatic diseases.

Dr Karen Schreiber main clinical and research interests are antiphospholipid syndrome and connective tissue diseases in pregnant women. Dr Schreiber is involved in identifying alternative treatment to improve fetal and maternal pregnancy outcomes in pregnant women with antiphospholipid syndrome. Dr Schreiber is an active member of the British Society for Rheumatology (BSR) working groups publishing clinical guidelines with the overall aim to improve the treatment of patients with rheumatic diseases. Dr. Chakravarty is a rheumatologist and epidemiologist with a longstanding clinical and research interest in understanding the interrelationships between pregnancy and underlying rheumatic diseases. She works to identify and mitigate risk factors for adverse pregnancy outcomes and to optimize medical management of chronic rheumatic diseases during pregnancy and the postpartum period in order to maximize outcomes for both mother and infant. Dr. Østensen is a rheumatologist with a special interest in the interaction between pregnancy and the rheumatic diseases. Her research through many years has focussed on reproduction issues of women and men with rheumatic disease; immunology of pregnancy; antirheumatic drugs during pregnancy and breastfeeding. She has established specialized centers at Rheumatology departments in Norway and in Switzerland that counsel and manage patients who plan a family or are pregnant.