About this Research Topic
Background: Systemic autoimmune rheumatic diseases (SARDs) most commonly affect female gender and present during childbearing years. Thanks to massive improvement in prognosis and quality of life, many patients embark upon one or multiple pregnancies despite a chronic disease and its many implications. However, women with SARDs still display a higher obstetric risk compared to the general population, both in terms of maternal and fetal complications. Optimal control of disease activity before conception and during gestation is the main determinant of good pregnancy outcome. Therefore, it is pivotal to optimize treatment in order to maintain disease activity under control avoiding any risk for the foetus. Indeed, some immunosuppressive drugs commonly used in the management of SARDs (e.g., cyclophosphamide, methotrexate and mycophenolate) must be avoided when seeking conception and during pregnancy, due to manifest fetal toxicity; in other cases, data are lacking thus limiting their use in pregnant women. Despite these limitations, there are still many options for rheumatologists: steroids, azathioprine, cyclosporine, hydroxychloroquine, low molecular weight heparin, low dose aspirin are allowed before and during gestation. Nowadays, the therapeutic armamentarium to manage pregnant women with SARDs includes even biological agents, as certolizumab and etanercept, which have been proved to be safe in this scenario. The experience with the use of some drugs during gestation is still recent, and there are many controversial issues about the effects of in utero exposure to synthetic and biological disease modifying anti-rheumatic drugs (DMARDs) on the health of children born to mothers with SARDs.
The post-partum period is burdened by a high rate of disease relapse, thus requiring a tight pharmacological management even once the baby is born. Treatment of breastfeeding mothers should be thus tailored in order to maintain disease control during puerperium, but accurate evaluations of the potential neonatal toxicity of maternal drugs.
Goal: Despite these many advancements, there are still many issues that should be unraveled to further improve the management of pregnant patients with SARDs. The aim of the present Research Topic would be to investigate the different implications of therapeutic approaches to SARDs on pregnant women and their offspring. The need of a chronic therapy during gestation and lactation might be a great concern for mothers, and data on the effect on children’s physical and neuropsychological development are highly necessary.
Scope: Manuscripts to be included in the present Research Topic should present insights into:
- disease activity and response to treatment during pregnancy in different SARDs;
- potential biomarkers to early identify women more likely to need or respond to a given treatment;
- in vivo and in vitro data of effects of drugs;
- strategies to improve communication between rheumatologists and pregnant patients and between rheumatologists and other clinicians on the use of DMARDs during pregnancy and lactation;
- unmet needs of patients with SARDs receiving treatment during pregnancy (e.g., need for psychological support);
- data on the short-term and long-term effects of in utero exposure to DMARDs.
Details for Authors: Original Research manuscripts or Review articles are acceptable for consideration.
Keywords: Rheumatology, synthetic DMARDs, biologic DMARDs, pregnancy, children
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.