Rheumatological Disorders

Pregnancy in women with rheumatological disorders, particularly systemic lupus erythematosus (SLE) and antiphospholipid syndrome, raises concern for potential exacerbation of maternal illness and increased risk of adverse pregnancy outcomes. This chapter focuses on SLE, rheumatoid arthritis (RA) and scleroderma. Recurrent spontaneous abortion and fetal loss are more common in women with SLE and co‐existing antiphospholipid antibodies. RA is thought to result from a combination of genetic and environmental interactions. The human leukocyte antigen and major histocompatibility genes are important in determining risk. Methotrexate and leflunomide are commonly used RA medications that are teratogenic and should be discontinued prior to pregnancy. Scleroderma is characterized by an autoimmune reaction causing fibroblast stimulation and overproduction, deposition and remodeling of collagen and other extracellular matrix proteins. Earlier reports suggested that scleroderma was associated with high rates of perinatal mortality due to preeclampsia, preterm birth, and stillbirth.