Pregnancy issues in rheumatic diseases

Pregnancy and lactation are periods that can be quite risky for female patients with rheumatic diseases. The risk of possible damage exists for the mother, for the fetus during pregnancy, and for the newborn during lactation. The risk arises both from the nature of the rheumatic disease itself and from the mother's therapy before conception and during pregnancy and lactation. The father's therapy in the period shortly before conception can also be a certain risk. Rheumatoid arthritis usually tends to improve during pregnancy but is similarly often followed by a relapse of the disease after childbirth. Pregnancy in patients with systemic lupus erythematosus represents the highest risk. The risk results from the disease itself and its expected course during pregnancy, its activity, the type of organ involvement, the  autoantibody spectrum, comorbidities, and also from the possible consequences of the mother's medication treatment. There is also a risk of developing lupus neonatorum with an irreversible atrioventricular block in a newborn of a mother with the positivity of anti-Ro and anti-La antibodies. The risk of repeated abortions is higher due to the possible presence of antiphospholipid syndrome. The nature of the systemic disease with the presence of autoantibodies with prothrombotic and proinflammatory activity can be the cause of a number of other complications during pregnancy, from a higher number of abortions, a higher incidence of preeclampsia, hypertension, fetal growth retardation to premature births. Immunosuppressive treatment also has serious risks with regard to pregnancy.