Pregnancy management in patients with autoimmune diseases: Review of practices for the management of pregnant women with autoimmune diseases

Abstract

Introduction: Pregnancy in patients with autoimmune diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), is often challenging due to the increased risks of maternal-fetal complications. Control of disease activity and appropriate drug management are essential to minimize these risks. This study reviews current management practices for pregnant women with autoimmune diseases, exploring therapeutic interventions, multidisciplinary approaches, and associated clinical outcomes. Methods: A systematic review of the literature was conducted using the PubMed, MEDLINE, and Google Scholar databases, covering studies published up to September 2024. Original articles, systematic reviews, clinical trials, and clinical practice guidelines in English, Portuguese, and Spanish that discussed the management of pregnancy in patients with SLE, RA, or antiphospholipid syndrome (APS) were included. The selection of studies considered the impact of different therapeutic strategies on maternal-fetal outcomes. The methodological quality of the studies was assessed using the Cochrane risk of bias tool and the GRADE system. Results: The results indicate that tight control of disease activity before conception significantly reduces the rates of complications such as preeclampsia, preterm birth, and fetal growth restriction. Medications such as methotrexate and mycophenolate mofetil were at high teratogenic risk and should be discontinued before pregnancy, while hydroxychloroquine, azathioprine, and corticosteroids were considered safe. Studies have shown that continued use of hydroxychloroquine was associated with lower rates of exacerbations of the disease and better gestational outcomes. In addition, multidisciplinary approaches, such as rheumatologist-led clinics, have been shown to be effective in improving maternal and fetal outcomes, reducing serious complications, and improving patients' quality of life. Conclusion: The management of pregnancy in patients with autoimmune diseases should be personalized, focusing on the prior and continuous control of disease activity and the careful choice of safe medications. Multidisciplinary strategies are key to optimizing maternal-fetal outcomes. While there are clear guidelines for SLE, RA, and APS, there is a need for more research to guide the management of less common autoimmune conditions and improve the care of these patients and their children.