HEALTH OF WOMAN. 2020.2(148): 42–51; doi 10.15574/HW.2020.148.42
Golovach I. Yu.¹, Yehudina Ye. D.^2
1Clinical Hospital «Feofania» of the State Administration of Affairs, Kiev
²Clinic of modern rheumatology, Kiev

Management of inflammatory rheumatic diseases in preconception period, pregnancy and breastfeeding has undergone significant changes over the past few years. Modern therapy, including biological and targeted synthetic disease modifying drugs, has significantly improved the control of rheumatic diseases, which has led to an increase in the patients’ number planning a pregnancy with serious diseases. When consulting such patients, it is necessary to discuss the possible time of conception (regarding the activity of the disease), the effect of the disease on pregnancy and pregnancy on the disease, as well as the potential need to change the regimen of medications during pregnancy and breastfeeding. This review summarizes information on the effects of pregnancy on various rheumatic diseases and vice versa, changes in therapy and monitoring of patients with rheumatic diseases before, during and after pregnancy.
Women with inflammatory rheumatic diseases need advice on drug therapy before planning pregnancy, during pregnancy, and breastfeeding. Safe disease-modifying drugs that can be taken during pregnancy are hydroxychloroquine, sulfosalazine, azathioprine, and cyclosporine. Glucocorticoids and non-steroidal anti-inflammatory drugs can also be taken up to 32 weeks of gestation. Most inhibitors of tumor necrosis factor (anti-TNF) are also safe during pregnancy. During pregnancy, a clear monitoring of the activity of the disease is necessary, control of the level of autoantibodies, especially anti-SSA / Ro and anti-SSB / La and antiphospholipid antibodies, an assessment of the degree of organ dysfunction, especially kidney damage.
Presented are modern approaches to optimizing the management of inflammatory rheumatic disease during pregnancy. For patients with inflammatory rheumatic diseases, a successful pregnancy outcome is optimized by creating an individual plan to suppress disease activity using a targeted approach.
Key words: pregnancy, rheumatic diseases, treatment, lactation, management tactics, drugs.

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