Managing Reproductive Issues in Spondyloarthritis, Myositis, and Systemic Sclerosis

Women with spondyloarthritis (SpA), systemic sclerosis (SSc), and idiopathic inflammatory myopathies (IIM) can have successful pregnancies. However, there is a higher risk of maternal and fetal complications as compared with the general population, requiring pregnancy planning and customized multidisciplinary care. Preconception counseling should assess disease activity, organ involvement, autoantibody status, and medication adjustments to ensure disease control with pregnancy-compatible drugs. Active disease, early discontinuation of biologic disease-modifying antirheumatic drugs, and organ involvement can increase the risk of flares and adverse pregnancy outcomes (APOs). In SpA, APOs include preterm delivery, pre-eclampsia, and higher caesarean section rates. In SSc and IIM, pregnancies carry an increased risk of intrauterine growth restriction, hypertensive disorders, and preterm birth, and a possible impact of cardiopulmonary involvement on overall prognosis. Close monitoring during pregnancy and postpartum allows early recognition of disease flares or obstetric complications, while preventive strategies such as low-dose aspirin may reduce risks. With pregnancy planning and compatible medications, and coordinated multidisciplinary care, most women with these conditions can achieve favorable pregnancy outcomes.