Preconceptional Counseling and Assessments in Autoimmune Rheumatic Diseases

Pregnancy in women with autoimmune rheumatic diseases requires meticulous preconceptional planning, multidisciplinary care, and close monitoring to optimize maternal and fetal outcomes. Disease activity at conception is a key determinant of pregnancy course, with remission or low disease activity associated with reduced flare risk. Specific conditions, such as systemic lupus erythematosus and antiphospholipid syndrome, present unique obstetric and perinatal challenges, including pre-eclampsia, intrauterine growth restriction, preterm birth, and fetal loss. Early risk stratification, baseline laboratory assessment, and tailored pharmacologic management, including continuation of pregnancy-compatible disease-modifying therapies, are essential. A review of fertility, contraception, and vaccinations is also essential. Genetic counseling should be considered where relevant. In addition, lifestyle aspects such as diet and physical activity should be addressed and mental health and emotional issues also need to be evaluated.