TY - JOUR
T1 - Immunology of pregnancy and reproductive health in autoimmune rheumatic diseases. Update from the 11th International Conference on Reproduction, Pregnancy and Rheumatic Diseases
AU - Andreoli, Laura
AU - Chighizola, Cecilia B.
AU - Iaccarino, Luca
AU - Botta, Angela
AU - Gerosa, Maria
AU - Ramoni, Véronique
AU - Tani, Chiara
AU - Bermas, Bonnie
AU - Brucato, Antonio
AU - Buyon, Jill
AU - Cetin, Irene
AU - Chambers, Christina D.
AU - Clowse, Megan E.B.
AU - Costedoat-Chalumeau, Nathalie
AU - Cutolo, Maurizio
AU - De Carolis, Sara
AU - Dolhain, Radboud
AU - Fazzi, Elisa M.
AU - Förger, Frauke
AU - Giles, Ian
AU - Haase, Isabell
AU - Khamashta, Munther
AU - Levy, Roger A.
AU - Meroni, Pier Luigi
AU - Mosca, Marta
AU - Nelson-Piercy, Catherine
AU - Raio, Luigi
AU - Salmon, Jane
AU - Villiger, Peter
AU - Wahren-Herlenius, Marie
AU - Wallenius, Marianne
AU - Zanardini, Cristina
AU - Shoenfeld, Yehuda
AU - Tincani, Angela
PY - 2023
Y1 - 2023
N2 - Autoimmune rheumatic diseases (ARD) can affect women and men during fertile age, therefore reproductive health is a priority issue in rheumatology. Many topics need to be considered during preconception counselling: fertility, the impact of disease-related factors on pregnancy outcomes, the influence of pregnancy on disease activity, the compatibility of medications with pregnancy and breastfeeding. Risk stratification and individualized treatment approach elaborated by a multidisciplinary team minimize the risk of adverse pregnancy outcomes (APO). Research has been focused on identifying biomarkers that can be predictive of APO. Specifically, preeclampsia and hypertensive disorders of pregnancy tend to develop more frequently in women with ARD. Placental insufficiency can lead to intrauterine growth restriction and small-for-gestational age newborns. Such APO have been shown to be associated with maternal disease activity in different ARD. Therefore, a key message to be addressed to the woman wishing for a pregnancy and to her family is that treatment with compatible drugs is the best way to ensure maternal and fetal wellbeing. An increasing number of medications have entered the management of ARD, but data about their use in pregnancy and lactation are scarce. More information is needed for most biologic drugs and their biosimilars, and for the so-called small molecules, while there is sufficient evidence to recommend the use of TNF inhibitors if needed for keeping maternal disease under control.Other issues related to the reproductive journey have emerged as "unmet needs", such as sexual dysfunction, contraception, medically assisted reproduction techniques, long-term outcome of children, and they will be addressed in this review paper.Collaborative research has been instrumental to reach current knowledge and the future will bring novel insights thanks to pregnancy registries and prospective studies that have been established in several Countries and to their joint efforts in merging data.
AB - Autoimmune rheumatic diseases (ARD) can affect women and men during fertile age, therefore reproductive health is a priority issue in rheumatology. Many topics need to be considered during preconception counselling: fertility, the impact of disease-related factors on pregnancy outcomes, the influence of pregnancy on disease activity, the compatibility of medications with pregnancy and breastfeeding. Risk stratification and individualized treatment approach elaborated by a multidisciplinary team minimize the risk of adverse pregnancy outcomes (APO). Research has been focused on identifying biomarkers that can be predictive of APO. Specifically, preeclampsia and hypertensive disorders of pregnancy tend to develop more frequently in women with ARD. Placental insufficiency can lead to intrauterine growth restriction and small-for-gestational age newborns. Such APO have been shown to be associated with maternal disease activity in different ARD. Therefore, a key message to be addressed to the woman wishing for a pregnancy and to her family is that treatment with compatible drugs is the best way to ensure maternal and fetal wellbeing. An increasing number of medications have entered the management of ARD, but data about their use in pregnancy and lactation are scarce. More information is needed for most biologic drugs and their biosimilars, and for the so-called small molecules, while there is sufficient evidence to recommend the use of TNF inhibitors if needed for keeping maternal disease under control.Other issues related to the reproductive journey have emerged as "unmet needs", such as sexual dysfunction, contraception, medically assisted reproduction techniques, long-term outcome of children, and they will be addressed in this review paper.Collaborative research has been instrumental to reach current knowledge and the future will bring novel insights thanks to pregnancy registries and prospective studies that have been established in several Countries and to their joint efforts in merging data.
KW - Anti-rheumatic drugs
KW - Assisted reproduction techniques
KW - Contraception
KW - Rheumatic diseases
KW - Pregnancy
KW - Reproductive health
KW - Fertility
KW - Anti-rheumatic drugs
KW - Assisted reproduction techniques
KW - Contraception
KW - Rheumatic diseases
KW - Pregnancy
KW - Reproductive health
KW - Fertility
UR - http://hdl.handle.net/10807/230952
U2 - 10.1016/j.autrev.2022.103259
DO - 10.1016/j.autrev.2022.103259
M3 - Article
SN - 1568-9972
VL - 22
SP - 103259
EP - 103259
JO - Autoimmunity Reviews
JF - Autoimmunity Reviews
ER -