Clinical Report: Reproductive Health Framework for Care
Overview
Patients with systemic autoimmune and rheumatic diseases face significant risks during pregnancy, but these risks can be mitigated through integrated sexual and reproductive health care in rheumatology. A proposed framework emphasizes the importance of patient-centered care and system-level changes to improve reproductive outcomes.
Background
Systemic autoimmune and rheumatic diseases (SARDs) are associated with increased risks of adverse pregnancy outcomes, including preeclampsia and fetal death. Despite these risks, many patients do not receive adequate reproductive health care, highlighting a critical gap in management. Addressing these gaps through a structured framework can enhance care delivery and improve outcomes for affected patients.
Data Highlights
Registry data indicated that 45% of nonpregnant patients with rheumatoid arthritis and 30% with systemic lupus erythematosus were prescribed at least one teratogenic medication. Among nearly 2,500 reproductive-age patients, only one-third had seen a gynecologist in two years.
Key Findings
Patients with SARDs are at increased risk for complications during pregnancy.
Only one-third of reproductive-age patients receiving rheumatology care had seen a gynecologist in the past two years.
Medication safety during pregnancy varies; hydroxychloroquine is generally compatible, while methotrexate is contraindicated.
90% of newly approved medications lack sufficient data on pregnancy safety.
Structural changes in care delivery are needed to improve coordination between rheumatologists and other healthcare providers.
Clinical Implications
Rheumatologists should incorporate sexual and reproductive health assessments into routine care for patients with SARDs. Enhanced collaboration with obstetricians and primary care providers is essential to ensure comprehensive reproductive health management.
Conclusion
Proactive and coordinated care in rheumatology can significantly improve reproductive outcomes for patients with systemic autoimmune and rheumatic diseases. The proposed framework serves as a guide for integrating reproductive health into clinical practice.
