Infectious comorbidities in pregnant patients with rheumatic diseases

Pregnancy fundamentally reshapes maternal immunity, creating a state of immune tolerance that simultaneously increases susceptibility to infections. In women with rheumatic diseases (RDs), this vulnerability is further amplified by underlying autoimmune dysregulation and immunosuppressive therapies. Infectious comorbidities in this population represent a major challenge as they may precipitate rheumatic disease flares, contribute to maternal morbidity, and adversely affect pregnancy, including miscarriage, preterm birth, fetal growth restriction, and neonatal complications. This review aims to overview current evidence on infectious comorbidities in pregnant patients with RDs, with a focus on rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and primary Sjögren syndrome. Disease-specific infection patterns and their impact on maternal and fetal outcomes are discussed. Literature searches were performed in Medline/PubMed, Scopus, Web of Science, and Directory of Open Access Journals (DOAJ) to identify documents on infections, prevention, and outcomes in pregnant women with RDs published up to September 2026. The influence of pregnancy-related immune modulation and immunosuppressive treatments, including corticosteroids, disease-modifying antirheumatic drugs, and biologic agents, on infection risk is examined. Preventive strategies, including preconception counseling, vaccination, targeted screening, and multidisciplinary management, are also addressed. Available evidence suggests that infectious comorbidities remain underrecognized in pregnancy counseling for women with RDs. Early risk stratification, individualized adjustment of immunosuppressive therapy, and close collaboration between rheumatologists, obstetricians, and infectologists are essential to optimize maternal and fetal outcomes.