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25.05.2019 | Original Article | Ausgabe 1/2020

Irish Journal of Medical Science (1971 -) 1/2020

A multidisciplinary approach to reproductive healthcare in women with rheumatic disease

Zeitschrift:
Irish Journal of Medical Science (1971 -) > Ausgabe 1/2020
Autoren:
Kieran Murray, Louise Moore, Celine O’Brien, Anne Clohessy, Caroline Brophy, Oliver FitzGerald, Eamonn S. Molloy, Anne-Barbara Mongey, Shane Higgins, Mary F. Higgins, Patricia Minnock, Joan Lalor, Fionnuala M. McAuliffe, Douglas James Veale
Wichtige Hinweise
Louise Moore and Kieran Murray both contributed equally to this paper and are co-first authors.

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Abstract

Introduction

Rheumatic disease (RD) patients when family planning must consider fertility, disease activity, and management from preconception to lactation. A clear understanding is necessary, especially for those receiving disease-modifying antirheumatic medications. Previous studies have highlighted unmet needs in the care of women with RDs with reproductive healthcare needs. This study describes the first published standardized reproductive care pathway for women with RDs and the outcomes of this approach.

Material and methods

We developed the care pathway with multidisciplinary input from rheumatologists, rheumatology nurse specialists, obstetricians, midwives, maternal medicine specialists, and pharmacists. We identified patients’ emotional and healthcare needs, ensured access to expert advice, maintenance of good disease control, and positive reproductive outcomes. We prospectively followed the patients and report the results of the service.

Results

Ninety-eight women with median age (range) of 35 years (19–48) were assessed. The majority had an inflammatory arthritis. Seventy-six babies were born to 62 mothers. There were 12 miscarriages and one perinatal death. Breastfeeding rates at 6 weeks were low (28%).

Conclusion

We describe the first published evidence-based integrated multidisciplinary reproductive care pathway for women with RDs and the results of this approach. Seventy percent of women successful in trying to conceive delivered a healthy baby, and 90% of patients were ‘very satisfied’ with the service.

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