Managing puerperium in patients with systemic autoimmune diseases: an update

ABSTRACT

Introduction

Puerperium is a critical period for patients affected by autoimmune rheumatic diseases for the risk of disease’s flares and difficulties in treating lactating mothers. We want to summarize the literature data about psychological and pharmacological management of these patients and possible risk factors of disease’s flares.

Areas covered

We made a narrative review on recent studies about puerperium in rheumatic autoimmune diseases patients.

Expert opinion

The physicians involved in management of patients during puerperium and in the follow-up of babies need to agree on maternal treatment because they need to reassure mothers about the safety of the prescribed medications. Furthermore, women with rheumatic diseases could present some musculoskeletal limitations and psychological problems, such as postpartum depression, which can lead to a sense of inadequacy to the mother’s task. Families and physicians should be aware of these possible complications and support the new mothers providing correct counseling and practical help.

KEYWORDS:

• Autoimmune rheumatic diseases
• breastfeeding
• chronic arthritis
• disease activity
• post-partum complications
• postpartum depression
• puerperium
• women’s health

Article highlights

• Puerperium is a period at higher risk of thrombosis and disease flare.

• Moderate-high disease activity before pregnancy is a risk factor for flares during puerperium.

• It is important to make a treatment plan for the postpartum period to minimize the risk of disease flare; maternal preference about breastfeeding should be taken into account in choosing drugs.

• Physicians must pay attention to postpartum depression and suggest referral to dedicated health services.

• Clinicians should counsel patients regarding medications during pregnancy and puerperium.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.