Pregnancy and autoimmune diseases

In an article in Best Practice and Research Clinical Rheumatology (18:3 2004 359-379) Caroline Gordon, a rheumatologist, outlines the pregnancy risk issues. Until about 15 years ago, the general advice to women with autoimmune rheumatic diseases, especially systemic lupus erythematosus, systemic sclerosis and vasculitic syndromes, was to avoid pregnancy as there was a high risk of maternal and fetal morbidity and mortality. However, it is now clear that these risks can be reduced in general by avoiding pregnancy when the diseases are active and continuing appropriate medication to reduce the chances of disease flare during pregnancy. The article reviews the evidence for this advice and also considers other issues that should be discussed with women before they attempt to become pregnant. This includes the influence of pregnancy on the individual autoimmune diseases.