Patients with systemic autoimmune and rheumatic diseases face elevated risks of adverse pregnancy and perinatal outcomes, but a narrative review and commentary suggest that some of these risks may be mitigated by integrating sexual and reproductive health care into routine rheumatology practice.

Mehret Birru Talabi, MD, of the University of Pittsburgh, and Sonya Borrero, MD, outlined a framework to help rheumatologists incorporate sexual and reproductive health care into clinical practice, emphasizing both patient-centered care and system-level changes.

Evidence Highlights Persistent Risks and Care Gaps

In the review, the researchers examined published studies, registry data, and professional guidance to identify key factors influencing reproductive outcomes in patients with systemic autoimmune and rheumatic diseases (SARDs).

These patients are at increased risk for complications such as preeclampsia, intrauterine growth restriction, and maternal or fetal death, particularly when disease is active before or during pregnancy.

Medication exposure also remains a concern. Registry data cited in the review showed that 45% of nonpregnant patients with rheumatoid arthritis and 30% with systemic lupus erythematosus were prescribed at least one teratogenic medication.

At the same time, gaps in care persist. Among nearly 2,500 reproductive-age patients receiving rheumatology care, only one-third had seen a gynecologist and two-thirds had seen a primary care clinician over a 2-year period.

The researchers emphasized that reproductive outcomes are shaped not only by disease activity and medication use but also by access to care, social determinants of health, and the availability and quality of sexual and reproductive health services. The researchers also highlight a broader shift toward more person-centered and autonomy-supportive approaches to reproductive care.

Framework Emphasizes Core Clinical Competencies

To address these gaps, the proposed framework outlines core competencies for rheumatologists, including:

• Assessing pregnancy preferences and reproductive goals

• Optimizing disease control prior to pregnancy

• Counseling on contraception and fertility

• Understanding medication safety during pregnancy and lactation

• Addressing menopause and sexual health

The review highlights that some commonly used therapies, including hydroxychloroquine and tumor necrosis factor inhibitors, are generally considered compatible with pregnancy, whereas others—such as methotrexate and mycophenolate—should not be used.

However, evidence gaps remain substantial. The researchers noted that 90% of newly approved medications lack sufficient human data on pregnancy safety, limiting clinicians’ ability to guide treatment decisions.

Systems-Level Changes May Be Needed

Beyond individual clinical practice, the framework calls for structural changes to improve care delivery. These include stronger collaboration between rheumatologists and ObGyn or primary care clinicians, clearer referral pathways, and expanded training in sexual and reproductive health during rheumatology fellowship.

The paper also highlights broader barriers, including limited access to reproductive health services and fragmentation of care, which may leave some patients without coordinated guidance on pregnancy planning, contraception, or medication safety.

Limitations

The framework is not comprehensive and primarily focuses on female patients, with limited discussion of adolescents, male patients, and LGBTQIA populations. The recommendations are intended to guide future research and clinical integration rather than establish definitive standards.

Conclusion

The researchers concluded that adverse reproductive outcomes in patients with SARDs should not be considered inevitable, emphasizing that more proactive, coordinated care in rheumatology may help improve outcomes.

Disclosures

Talabi reported consulting for the US Office of Population Affairs and the Centers for Disease Control and Prevention and receiving grant funding. Borrero reported consulting for the US Office of Population Affairs and receiving grant funding. No other disclosures were reported.

Source: Arthritis Care & Research