Management of pregnant with rheumatoid arthritis: Preconception care, pregnancy and lactation strategies, and maternal-fetal outcomes.

IF 4.5 2区医学 Q1 RHEUMATOLOGY Best Practice & Research in Clinical Rheumatology Pub Date : 2024-11-20 DOI:10.1016/j.berh.2024.102022

Takehiro Nakai, Sho Fukui, Hiroki Ozawa, Ayako Kitada, Masato Okada, Mitsumasa Kishimoto

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Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that can affect women of reproductive age. In recent decades, significant advances have been made in the development of new medications, including biologic disease-modifying anti-rheumatic drugs (DMARDs) and Janus kinase (JAK) inhibitors. Women with RA are prone to infertility, with 42% experiencing a time to pregnancy exceeding 12 months. High disease activity, as well as the use of high-dose glucocorticoids and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), are associated with infertility and adverse pregnancy outcomes. Additionally, some medications, such as methotrexate, are linked to teratogenicity, highlighting the importance of providing preconception care in everyday practice. Recent advancements in reproductive care have improved our ability to manage RA during pregnancy, leading to better pregnancy outcomes. In this review, we summarize key aspects of fertility care, pregnancy and lactation management, including medication strategies, neonatal vaccination, and long-term outcomes for offspring born to mothers with RA.

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类风湿性关节炎孕妇的管理：孕前保健、孕期和哺乳期策略以及母胎结局。

类风湿性关节炎（RA）是一种慢性炎症性疾病，可影响育龄妇女。近几十年来，新药研发取得了重大进展，包括生物制剂改变病情抗风湿药（DMARDs）和Janus激酶（JAK）抑制剂。患有RA的妇女容易不孕，42%的妇女怀孕时间超过12个月。疾病活动度高以及使用大剂量糖皮质激素和非甾体抗炎药（NSAIDs）与不孕和不良妊娠结局有关。此外，一些药物（如甲氨蝶呤）还与致畸有关，这突出了在日常工作中提供孕前保健的重要性。生殖保健领域的最新进展提高了我们在孕期管理 RA 的能力，从而改善了妊娠结局。在这篇综述中，我们总结了生育护理、孕期和哺乳期管理的主要方面，包括用药策略、新生儿疫苗接种以及RA母亲所生后代的长期预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Best Practice & Research in Clinical Rheumatology 医学-风湿病学

CiteScore

9.40

自引率

0.00%

发文量

审稿时长

27 days

期刊介绍： Evidence-based updates of best clinical practice across the spectrum of musculoskeletal conditions. Best Practice & Research: Clinical Rheumatology keeps the clinician or trainee informed of the latest developments and current recommended practice in the rapidly advancing fields of musculoskeletal conditions and science. The series provides a continuous update of current clinical practice. It is a topical serial publication that covers the spectrum of musculoskeletal conditions in a 4-year cycle. Each topic-based issue contains around 200 pages of practical, evidence-based review articles, which integrate the results from the latest original research with current clinical practice and thinking to provide a continuous update. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. The review articles seek to address the clinical issues of diagnosis, treatment and patient management. Management is described in practical terms so that it can be applied to the individual patient. The serial is aimed at the physician in both practice and training.