Fertility and pregnancy outcomes in patients with immune-mediated rheumatic diseases

Impaired fertility is an important public health concern, especially in patients with immune-mediated rheumatic conditions. Frequency of infertility /subfertility vary among rheumatic diseases – higher in systemic lupus erythematosus or rheumatoid arthritis, than in other autoimmune diseases. Risk factors like age, nulliparity, disease activity or medication such as NSAIDs, corticosteroids, cyclophosphamide are mostly encountered. Treating a pregnant woman is a challenge: the well-being of mother and child has to be considered, as tight disease control before, during pregnancy and postpartum is mandatory to minimize adverse outcome risk. Safety of biological therapies during preconception, pregnancy, and postpartum is crucial, anti-TNFs being safe in early pregnancy, second, but not third trimester. Etanercept and certolizumab may be considered for use throughout pregnancy due to low rate of transplacental passage. Concerning the child, live-attenuated vaccines are to be avoided for the first 6 months of life due to persistence of biologics.