Reproductive Health Framework for Care

Narrative review and commentary proposes framework to address care gaps beyond disease control

Category	Detail
Condition	Systemic Autoimmune and Rheumatic Diseases (SARDs)
Key Mechanisms	Integration of sexual and reproductive health care into routine rheumatology practice.
Target Population	Patients with systemic autoimmune and rheumatic diseases, particularly reproductive-age women.
Care Setting	Rheumatology clinics with collaboration from ObGyn and primary care.

Patients with SARDs face elevated risks of adverse pregnancy outcomes.
Only one-third of reproductive-age patients in rheumatology have seen a gynecologist.
Medication safety during pregnancy is a significant concern, with many patients on teratogenic medications.
Core competencies for rheumatologists include assessing pregnancy preferences and optimizing disease control.
Structural changes are needed to improve care delivery and collaboration.

Regularly evaluate disease activity and medication effects on reproductive health.

Increased risk for complications such as preeclampsia and intrauterine growth restriction.

Reproductive-age patients with systemic autoimmune and rheumatic diseases.

Hydroxychloroquine and TNF inhibitors are generally compatible with pregnancy; methotrexate and mycophenolate are contraindicated.

Implement person-centered and autonomy-supportive approaches to reproductive care.
Enhance collaboration between rheumatologists and ObGyn or primary care clinicians.
Expand training in sexual and reproductive health during rheumatology fellowship.