Barriers to Appropriate Care in Pregnancy for Patients with Rheumatic Diseases

Pregnancy constitutes a critical period for people diagnosed with autoimmune inflammatory rheumatic diseases (AIRDs), during which distinctive challenges are important to ensure favourable maternal and offspring outcomes. Despite considerable advances in addressing reproductive health care and family planning in rheumatology, individuals with AIRDs continue to confront complex barriers spanning biological and social domains, each with the potential to undermine comprehensive and equitable reproductive care. Biological barriers include unpredictable disease trajectories, limitations, and ambiguities regarding the teratogenicity and safety profile of disease-modifying anti-rheumatic drugs (DMARDs), and the pathogenic roles of autoantibodies. These factors are further complicated by comorbidities and physiologic changes in pregnancy, in addition to insufficient consideration of male fertility and paternal exposures. Social determinants include limited access to credible, timely information regarding reproductive health in AIRDs, which remain pervasive, often exacerbated by socioeconomic and geographic inequities, entrenched cultural stigma, restrictive gender norms, and variable provider expertise or confidence in reproductive counselling. A persistent evidence gap, resulting from the historic exclusion of pregnant individuals with AIRDs from prospective studies, further fuels uncertainty in both clinical guidance and regulatory standards. The reduced availability of data on male fertility and the impact of DMARD treatment on the foetus is also an important barrier. Collectively, these variables often necessitate nuanced, multidisciplinary management and reliance on current, harmonized clinical guidelines, resources that are not uniformly available across healthcare settings.