Background/Purpose

Rheumatological diseases often affect women of reproductive age and can impact pregnancy outcomes. There is a need to understand how patients (pts) are managed by their rheumatologists. We investigate the treatment pathway and care of women with rheumatological conditions who become pregnant.

Methods

Two online surveys, one in rheumatologists and one in pts, were undertaken. Surveys were conducted in the US, UK, Germany and Mexico. Rheumatologists were questioned on the last three pts who they have consulted whilst being pregnant or considering becoming pregnant. Rheumatologists were questioned on pts with rheumatoid arthritis (RA) and lupus. Pt survey included women with RA who had been pregnant in the past 2 years. Pts were questioned on their interactions with rheumatologists and obstetrics/gynaecology physicians (OBGYN).

Results 30 rheumatologists completed the physician survey. 57 RA pts completed the pt survey. Rheumatologists were aware of the pt’s intention to become pregnant in 70% of pts. When planning their pregnancy 44% of pts consulted with their rheumatologist and 51% with their OBGYN. On learning they were pregnant 33% of pts consulted with their rheumatologist and 61% with their OBGYN. For rheumatologists the majority of initial visits occurred prior to pregnancy (70%). During pregnancy rheumatologists saw 43% of pts once a month or more, 42% every trimester and 14% only once during pregnancy. 83% of pts reported that rheumatologists were very influential on how they managed their pregnancy. For OBGYN, this figure was 87%. The majority of pts rated the level of information reliability on managing disease from both rheumatologists and OBGYNs as very reliable. A treatment plan related to management of RA or pregnancy was initiated by rheumatologists for 56% of pts. 51% of pts reported they had a treatment plan in place prior to pregnancy. 60% of rheumatologists made treatment changes in anticipation of or during pregnancy. When considering treatment switches during pregnancy, rheumatologists increased steroid use and decreased biologic use (Table). For rheumatologists, the most common reason for switch was the pt requesting a change due to medication concerns (43%).

Conclusion The involvement of rheumatologists in the management of women with rheumatological conditions who are planning to become or are pregnant is high, and they have substantial influence on how pts manage their pregnancy. The patients had a high level of interaction with both rheumatologists and OBGYN throughout the journey. This emphasizes the importance of cross-collaborative care and the sharing of information between specialists involved in the management of women with rheumatological conditions during family planning and pregnancy.