General approach: Pre-pregnancy assessment of the rheumatic disease patient

Pregnancy in rheumatic disease patients is increasingly common: more effective therapies, recognition of pregnancy risk factors, and improved obstetric care provide many patients the option of pursuing pregnancy. Optimizing maternal and fetal outcomes relies on identifying patients without serious end-organ damage for whom pregnancy is feasible, planning for pregnancy during a period of well-controlled disease, and ensuring that medications are both effective and compatible with pregnancy. For any rheumatic disease patient, pre-pregnancy assessment of risk for maternal and obstetric complications is critical, as is effective counseling of both the patient and her partner regarding risk and prognosis. Rheumatic disease patients benefit from coordinated rheumatology and obstetric care that is individualized to the patient's diagnosis and particular clinical situation: pregnancy outcome is optimized when the rheumatologist, obstetrician, other involved specialists and patient establish a plan of care early and communicate frequently.