title: State of the art: Reproduction and pregnancy in rheumatic diseases.
abstract: Throughout the last decade, increasing awareness has been raised on issues related to reproduction in rheumatic diseases including basic research to clarify the important role of estrogens in the etiology and pathophysiology of immune/inflammatory diseases. Sub- or infertility is a heterogeneous condition that can be related to immunological mechanisms, to pregnancy loss, to disease burden, to therapy, and to choices in regard to family size. Progress in reproductive medicine has made it possible for more patients with rheumatic disease to have children. Active disease in women with rheumatoid arthritis (RA) affects their children's birth weight and may have long-term effects on their future health status. Pregnancy complications as preeclampsia and intrauterine growth restriction are still increased in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), however, biomarkers can monitor adverse events, and several new therapies may improve outcomes. Pregnancies in women with APS remain a challenge, and better therapies for the obstetric APS are needed. New prospective studies indicate improved outcomes for pregnancies in women with rare diseases like systemic sclerosis and vasculitis. TNF inhibitors hold promise for maintaining remission in rheumatological patients and may be continued at least in the first half of pregnancy. Pre-conceptional counseling and interdisciplinary management of pregnancies are essential for ensuring optimal pregnancy outcomes.
authors.affiliation: National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olavs Hospital, University Hospital of Trondheim, Norway. Electronic address: monika.ostensen@gmail.com.
authors.forename: Monika
authors.initials: M
authors.lastname: Østensen
authors.affiliation: Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Andreoli
authors.affiliation: Department of Internal Medicine, Ospedale papa Giovanni XXIII Bergamo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Brucato
authors.affiliation: Department of Mother and Child, Hospital Luigi Sacco, University of Milano, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Cetin
authors.affiliation: Department of Pediatrics, University of California San Diego, La Jolla, CA 92093-0828, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Chambers
authors.affiliation: Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Megan E B
authors.initials: ME
authors.lastname: Clowse
authors.affiliation: Université Paris-Descartes, Paris, France; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.affiliation: Research Laboratories and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cutolo
authors.affiliation: Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Radboud
authors.initials: R
authors.lastname: Dolhain
authors.affiliation: Department of Immunology and Transfusion Medicine, St. Olavs Hospital, Trondheim, Norway.
authors.forename: M H
authors.initials: MH
authors.lastname: Fenstad
authors.affiliation: Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, CH-3010 Bern, Switzerland.
authors.forename: Frauke
authors.initials: F
authors.lastname: Förger
authors.affiliation: Department of Medicine, Centre for Molecular Medicine, Karolinska Universitetssjukhuset, Stockholm, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Wahren-Herlenius
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.affiliation: National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St. Olavs Hospital, University Hospital of Trondheim, Norway.
authors.forename: Hege
authors.initials: H
authors.lastname: Koksvik
authors.affiliation: Women's Health Academic Centre, St Thomas' Hospital, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Nelson-Piercy
authors.affiliation: Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
authors.affiliation: Department of Rheumatology and Clinical Immunology, Ospedale Civile and University of Brescia, Brescia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.affiliation: Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Villiger
authors.affiliation: National Service for Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, Trondheim, Norway; Dept of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Marianne
authors.initials: M
authors.lastname: Wallenius
authors.affiliation: University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Berne, Berne, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: von Wolff
mesh_terms: D000818:Animals; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012098:Reproduction; D012216:Rheumatic Diseases / Q000628:therapy
keywords: Fertility; Hormones; Placenta; Pregnancy complications; Rheumatic Diseases; TNF inhibitors