Practical management of the pregnant patient with rheumatic disease

Edited by Karen Schreiber, Eliza Chakravarty, and Monika Østensen

The first of its kind, this handbook provides a comprehensive collection of cases covering rheumatic diseases in pregnancy and its management.
Written by experts in the field, this book provides evidence and recommendations for the management of rheumatic diseases during pregnancy.
Case-based quick-access guide on the interplay between pregnancy and rheumatic diseases and principles of management before, during and after pregnancy.

Practical management of the pregnant patient with rheumatic disease

Edited by Karen Schreiber, Eliza Chakravarty, and Monika Østensen

Description

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.

Practical management of the pregnant patient with rheumatic disease

Edited by Karen Schreiber, Eliza Chakravarty, and Monika Østensen

Section One: Counselling
1:Important points of pre-pregnancy counselling, Monika Østensen
Section Two: Patients with pre-pregnancy complications
2.1:Thrombotic Complications in pregnant patients with rheumatic disease, Andrew James Doyle and Beverley Jane Hunt
2.2:Prevention of postpartum venous thromboembolism (VTE), Roseann O'Doherty and Fionnuala Ní Ainle
2.3:Pulmonary Arterial Hypertension, Eliza Chakravarty
2.4:Advanced renal disease / renal impairment, Hannah Blakey and Kate Bramham
2.5:Antibodies as risk factors for adverse maternal and fetal outcomes, Massimo Radin, Karen Schreiber, and Savino Sciascia
Section Three: Adjustment of therapy before/during pregnancy and lactation
3.1:Disease modifying drugs, biological drugs and concomitant medications before/during pregnancy and lactation, Monika Østensen and Ian Giles
3.2:Managing a patient exposed to a teratogenic drug at different stages of pregnancy, Christof Schaefer
Section Four: Infection during pregnancy
4:Infection in a pregnant patient on immunosuppressive treatment, Maria Rhona G. Bergantin and Sandra V. Navarra
Section Five: Organ specific flares during pregnancy
5:Managing Organ Specific Flares, Bonnie L. Bermas and Eliza Chakravarty
Section Six: Obstetric complications in women with autoimmune diseases
6:Pregnancy and Obstetric Complications in Women with Autoimmune Diseases, D. Ware Branch
Section Seven: Vaccination before or during pregnancy
7:Vaccination before or during pregnancy, Cara D Varley and Kevin L Winthrop
Section Eight: Rare diseases in pregnancy
8.1:SLE, Karen Schreiber and Monika Ostensen
8.2:Systemic lupus erythematosus and the risk of cardiovascular disease, Karen Schreiber and Soeren Jacobsen
8.3:3 Antiphospholipid syndrome, Karen Schreiber and Savino Sciascia
8.4:Vasculitis in Pregnancy, Megan Clowse and Jon Golenbiewski
8.5:Systemic sclerosis, Eliza Chakravarty
8.6:Myositis and Pregnancy, Muhammed Shipa and David Isenberg
8.7:Ankylosing spondylitis in pregnancy, Monika Østensen

Practical management of the pregnant patient with rheumatic disease

Edited by Karen Schreiber, Eliza Chakravarty, and Monika Østensen

Author Information

Edited by Karen Schreiber, Danish Hospital for Rheumatic Diseases, Sonderburg, Denmark, Eliza Chakravarty, Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, USA, and Monika Østensen, Professor of Rheumatology, Department of Rheumatology, Sorlandet Hospital, Kristiansand, Norway

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.

Contributors:

Maria Rhona G. Bergantin, Department of Rheumatology, University of Santo Tomas, Faculty of Medicine & Surgery, Manila, Philippines
Bonnie L. Bermas, Internal Medicine, UT Southwestern Medical Center, Dallas, USA
Hannah Blakey, Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
Kate Bramham, Women and Children's Health, King's College London, London, UK
D. Ware Branch, Maternal-Fetal Medicine, University of Utah Medical Center, Salt Lake City, USA
Eliza Chakravarty, Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, USA
Megan Clowse, Department of Medicine, Duke University School of Medicine, Durham, USA
Andrew James Doyle, Thrombosis and Haemophilia, Guy's and St Thomas' NHS Foundation Trust, London, UK
Ian Giles, Centre for Rheumatology, University College London, London, UK
Jon Golenbiewski, Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, USA
Beverley Jane Hunt, Thrombosis and Haemophilia, Guy's and St Thomas' NHS Foundation Trust, London, UK
David Isenberg, Centre for Rheumatology, University College London, London, UK
Søren Jacobsen, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Fionnuala Ní Ainle, Department of Haematology, Mater Misericordiae University Hospital, Dublin Ireland.
Sandra V. Navarra, Department of Rheumatology, University of Santo Tomas, Manila, Phillippines
Roseann O'Doherty, The Mater Hospital, Ireland
Monika Østensen, Department of Rheumatology, Sorlandet Hospital, Kristiansand, , Norway
Massimo Radin, Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni BoscoHospital, Turin, Italy.
Karen Schreiber, Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark; Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen, Denmark and Thrombosis and Haemophilia, Guy's and St Thomas' NHS Foundation Trust, London, UK
Savino Sciascia, Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
Christof Schaefer, Charité · Pharmakovigilanzzentrum Embryonaltoxikologie, Charité Universitätsmedizin Berlin, Germany
Muhammed Shipa, North Middlesex University Hospital NHS Trust, UK
Cara D Varley, Oregon Health and Science University School of Medicine, Portland, USA
Kevin L Winthrop, Center for Infectious Disease Studiess, Oregon Health and Science University, Portland, USA