[Pregnancy associated with connective tissue disease]

The majority of connective tissue diseases, with the exception of scleroderma which is usually diagnosed past the age of 40 years, may affect women of reproductive age. Questions concerning the impact of the connective tissue disease upon pregnancy, interactions of pregnancy with the disease, and influence of the disease on fetal development are not easily answered. However, our knowledge on the pathogenesis of connective tissue diseases and the mechanisms of action of various antibodies is increasing, enabling improved disease control and reduction of adverse pregnancy outcomes. Multicenter, prospective clinical studies verified some unproven opinions about the adverse influence of pregnancy on scleroderma or systemic lupus erythematosus, as well as about their unavoidably fatal interactions with pregnancy. Careful pregnancy planning and cooperation of the rheumatologist, obstetrician and neonatologist helps avoid disease exacerbation and fetal misdevelopment. Acetylsalicylic acid and heparin reduce the adverse effect of antiphospholipid antibodies. Still, miscarriage, intrauterine fetal death, intrauterine growth retardation, and prematurity are more often encountered in women with systemic lupus erythematosus. However, the risk of adverse pregnancy outcome in these patients is gradually falling. Active lupus nephritis, hypertension, presence of antiphospholipid antibodies, and history of miscarriage are important risk factors. Pregnancy in women with diffuse type of scleroderma is of worse prognosis, often resulting in prematurity and low birthweight. Establishing the risk of immunosupressive and anti-inflammatory therapies enables better treatment of connective tissue diseases in pregnancy. Currently there is no doubt that pregnancy is contraindicated only in a small group of high-risk patients with connective tissue disease.