Evaluation and management of systemic lupus erythematosus and rheumatoid arthritis during pregnancy

• Pregnancy can be a challenge to manage in patients with rheumatic diseases.
• Changes during pregnancy can mimic or exacerbate the underlying rheumatic disease.
• Recent advancements have improved management of pregnancy in these patients.
• Pregnancy is now a realistic option for most rheumatology patients.

Women of childbearing age are at risk for developing systemic rheumatic diseases. Pregnancy can be challenging to manage in patients with rheumatic diseases for a variety of reasons including the impact of physiological and immunological changes of pregnancy on underlying disease activity, the varied presentation of rheumatic disease during pregnancy, and the limited treatment options. Previously, patients with rheumatic disease were often advised against pregnancy due to concerns of increased maternal and fetal morbidity and mortality. However, recent advancements in the understanding of the interaction between pregnancy and rheumatic disease have changed how we counsel patients. Patients with rheumatic disease can have successful pregnancy outcomes, particularly when a collaborative approach between the rheumatologist and obstetrician is applied. This review aims to discuss the effect of pregnancy on patients with the most common rheumatic diseases, the effect of these diseases on the pregnancy itself, and the management of these patients during pregnancy.