Immunology of pregnancy and reproductive health in autoimmune rheumatic diseases. Update from the 11th International Conference on Reproduction, Pregnancy and Rheumatic Diseases

Laura Andreoli, Cecilia B. Chighizola, Luca Iaccarino, Angela Botta, Maria Gerosa, Véronique Ramoni, Chiara Tani, Bonnie Bermas, Antonio Brucato, Jill Buyon, Irene Cetin, Christina D. Chambers, Megan E.B. Clowse, Nathalie Costedoat-Chalumeau, Maurizio Cutolo, Sara De Carolis, Radboud Dolhain, Elisa M. Fazzi, Frauke Förger, Ian GilesIsabell Haase, Munther Khamashta, Roger A. Levy, Pier Luigi Meroni, Marta Mosca, Catherine Nelson-Piercy, Luigi Raio, Jane Salmon, Peter Villiger, Marie Wahren-Herlenius, Marianne Wallenius, Cristina Zanardini, Yehuda Shoenfeld, Angela Tincani*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review


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.

Original languageEnglish
Article number103259
JournalAutoimmunity Reviews
Issue number3
Publication statusPublished - Mar 2023

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