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Schenone C, Pacini G, Gotelli E, Hysa E, Campitiello R, Sammorì S, Paolino S, Sulli A, Cutolo M. Updating on pregnancy in rheumatoid arthritis. Expert Rev Clin Immunol 2024; 20:1041-1052. [PMID: 38748553 DOI: 10.1080/1744666x.2024.2356164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Rheumatoid arthritis (RA), the most prevalent autoimmune disease in reproductive years, exhibits a higher incidence in females, suggesting involvement of estrogens, genetics and environmental factors in disease onset. Literature shows smaller families in RA patients, driving increased interest in Assisted Reproductive Techniques. AREAS COVERED This review elucidates how immunotolerance mechanisms contribute to favorable pregnancy outcomes in RA, emphasizing the need for a careful pregnancy planning to mitigate fetal complications and postnatal flares, which surpass those in the general population. A thorough medication evaluation, orchestrated by a multidisciplinary team, is imperative during pregnancy, weighing potential teratogenic effects against safer alternatives to balance medication safety with disease control. A systematic literature search on PubMed and MEDLINE, using specific terms, covered relevant academic journals up to the latest date. EXPERT OPINION This narrative review comprehensively addresses pregnancy-related considerations in RA patients, prioritizing meticulous disease management with pregnancy and breastfeeding-compatible drugs in line with the latest recommendations and registry data. The focus remains on evaluating glucocorticoids, conventional, and biological disease-modifying drugs for compatibility during pregnancy and breastfeeding. Additionally, the evolving landscape of targeted synthetic drugs during pregnancy is explored, providing insights into the latest developments in rheumatological care.
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Affiliation(s)
- Carlotta Schenone
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
| | - Greta Pacini
- Rheumatology Unit, Santa Chiara Hospital, APSS Trento, Trento, Italy
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
| | - Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
| | - Rosanna Campitiello
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Silvia Sammorì
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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Ladores S, Campbell CM, Bray LA, Li P, Brown J, Woods B, Corcoran J. Fertility preservation in women with cystic fibrosis pre-lung transplantation: A mixed methods study. J Adv Nurs 2021; 78:532-540. [PMID: 34806231 DOI: 10.1111/jan.15099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/17/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
AIMS Explore the knowledge, experiences, preferences, and concerns related to fertility preservation as an option for building a biological family among women with cystic fibrosis. DESIGN Convergent mixed methods study design. METHODS We recruited women with cystic fibrosis of childbearing age in the United States through cystic fibrosis centres, snowball sampling, and social media. Participants completed an anonymous survey about fertility and fertility preservation (n = 50). We also conducted audio-recorded, semi-structured interviews with a subset of women to gain a better understanding of their perspectives (n = 20). We transcribed the interviews verbatim and analysed them using thematic analysis. RESULTS For the quantitative arm, 78% of women indicated that they would like to have a child in the future; however, 74% reported never having had conversations about fertility preservation with their providers. For the qualitative arm, four major themes emerged: (1) Women with cystic fibrosis have inadequate knowledge about fertility and fertility preservation; (2) fertility is a low priority area for the cystic fibrosis care team; (3) women with cystic fibrosis recommend that the cystic fibrosis care team provide specific fertility resources; and (4) providers and literature lack information on fertility and cystic fibrosis. Integrated findings identified that while the majority of women with cystic fibrosis want to become mothers in the future, including post-lung transplantation, they have not received education on fertility preservation, and there is a general lack of knowledge on the topic of fertility in cystic fibrosis. CONCLUSION Women with cystic fibrosis desire to have children but have little knowledge about fertility preservation, and cystic fibrosis providers do not initiate family planning discussions. IMPACT Findings from the study support that additional education is needed for women with cystic fibrosis who are considering parenthood. Clinical care models should include early, regular, and thoughtful discussions about reproductive health issues, including fertility preservation.
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Affiliation(s)
- Sigrid Ladores
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Leigh Ann Bray
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Janet Brown
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brittany Woods
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica Corcoran
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Stransky O, Hunt N, Richards JS, Birru Talabi M. Exploring Family Planning, Parenting, and Sexual and Reproductive Health Care Experiences of Men with Rheumatic Diseases. J Rheumatol 2021; 49:251-255. [PMID: 34782452 DOI: 10.3899/jrheum.210785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore family planning, parenting, and sexual and reproductive health (SRH) care needs and experiences of men with rheumatic diseases. METHODS Men aged 18-45 years who were diagnosed with at least one rheumatic disease and used at least one anti-rheumatic drug were recruited from rheumatology clinics. Research coordinators engaged participants in semi-structured phone interviews. A codebook was developed based on the interview transcripts and used to conduct an inductive thematic analysis. RESULTS Participants ranged in age from 22 to 44 years old (N=20). Most were heterosexual and had at least one child. The most common disease diagnoses were spondyloarthritis, systemic lupus erythematosus, and rheumatoid arthritis. Four themes emerged from the interviews: 1) Men had family planning concerns, particularly related to the heritability of their diseases, their fertility, and potential effects of their medications on their offspring's health; 2) Men felt that fatigue, disability, and/or pain from their diseases either impaired or would impair their abilities to parent; 3) Men often did not discuss sexual dysfunction with their rheumatologists, even when they believed that it arose from their diseases or anti-rheumatic drugs; 4) Men rarely discussed any family planning, parenting, or SRH issues with their rheumatologists-and gender discordance with rheumatologists did not affect men's comfort in discussing these issues. CONCLUSION Men expressed concerns related to family planning, parenting, and SRH, which they rarely discussed with their rheumatologists. Our study suggests that some men's SRH information needs are incompletely addressed in the rheumatology clinical setting.
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Affiliation(s)
- Olivia Stransky
- Center for Women's Health Research and Innovation (CWHRI), Pittsburgh, PA; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Rheumatology Section, Medicine Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA. Conflict of Interest: Dr. Birru Talabi's work was supported by the Harold Amos Medical Faculty Development Program (grant). The authors do not have any financial interests or conflicts of interest to disclose. Corresponding Author Mehret Birru Talabi, S700 Biomedical Science Tower; 3500 Lothrop Street Pittsburgh, PA 15261
| | - Nicole Hunt
- Center for Women's Health Research and Innovation (CWHRI), Pittsburgh, PA; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Rheumatology Section, Medicine Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA. Conflict of Interest: Dr. Birru Talabi's work was supported by the Harold Amos Medical Faculty Development Program (grant). The authors do not have any financial interests or conflicts of interest to disclose. Corresponding Author Mehret Birru Talabi, S700 Biomedical Science Tower; 3500 Lothrop Street Pittsburgh, PA 15261
| | - John Steuart Richards
- Center for Women's Health Research and Innovation (CWHRI), Pittsburgh, PA; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Rheumatology Section, Medicine Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA. Conflict of Interest: Dr. Birru Talabi's work was supported by the Harold Amos Medical Faculty Development Program (grant). The authors do not have any financial interests or conflicts of interest to disclose. Corresponding Author Mehret Birru Talabi, S700 Biomedical Science Tower; 3500 Lothrop Street Pittsburgh, PA 15261
| | - Mehret Birru Talabi
- Center for Women's Health Research and Innovation (CWHRI), Pittsburgh, PA; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Rheumatology Section, Medicine Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA. Conflict of Interest: Dr. Birru Talabi's work was supported by the Harold Amos Medical Faculty Development Program (grant). The authors do not have any financial interests or conflicts of interest to disclose. Corresponding Author Mehret Birru Talabi, S700 Biomedical Science Tower; 3500 Lothrop Street Pittsburgh, PA 15261
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Long-term Outcome of Children Born to Women with Autoimmune Rheumatic Diseases: A Multicentre, Nationwide Study on 299 Randomly Selected Individuals. Clin Rev Allergy Immunol 2021; 62:346-353. [PMID: 33725262 PMCID: PMC8994724 DOI: 10.1007/s12016-021-08857-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 10/26/2022]
Abstract
The concern about the offspring's health is one of the reasons for a reduced family size of women with rheumatic diseases (RD). Increased risk of autoimmune diseases (AD) and neurodevelopmental disorders (ND) has been reported in children born to patients with RD. Within a nationwide survey about reproductive issues of women with RD, we aimed at exploring the long-term outcome of their children. By surveying 398 patients who received their diagnosis of RD during childbearing age (before the age of 45), information about the offspring were obtained from 230 women who declared to have had children. A total of 148 (64.3%) patients were affected by connective tissue diseases (CTD) and 82 (35.7%) by chronic arthritis. Data on 299 children (156 males, 52.1%; mean age at the time of interview 17.1 ± 9.7 years) were collected. Twelve children (4.0%), who were born to patients with CTD in 75% of the cases, were affected by AD (8 cases of celiac disease). Eleven children had a certified diagnosis of ND (3.6%; 6 cases of learning disabilities); 9 of them were born to mothers with CTD (5 after maternal diagnosis). No association was found between ND and prenatal exposure to either maternal autoantibodies or anti-rheumatic drugs. Absolute numbers of offspring affected by AD and ND were low in a multicentre cohort of Italian women with RD. This information can be helpful for the counselling about reproductive issues, as the health outcomes of the offspring might not be an issue which discourage women with RD from having children.
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