Rheumatic diseases in pregnant women: clinical and therapeutic challenges

Pregnancy in patients with autoimmune rheumatic diseases represents a highly complex scenario, where the interaction between the underlying pathology and the physiological changes of pregnancy poses significant challenges for both the mother and the fetus. Historically, the diagnosis of diseases such as systemic lupus erythematosus and rheumatoid arthritis in women of childbearing age brought unfavorable prognoses, but the advancement of knowledge in reproductive immunology and the optimization of disease-modifying therapies have transformed this landscape. This study aimed to perform a systematic review of the Brazilian literature on the clinical challenges and therapeutic strategies employed in the management of pregnant women with rheumatic diseases, aiming to identify the best practices to ensure maternal-fetal safety. The methodology consisted of a detailed analysis of articles published in national scientific databases, focusing on guidelines for controlling inflammatory activity and adjusting drugs during the gestational period. The results indicate that planning pregnancy during periods of clinical remission is the single most important factor for the success of the obstetric outcome, being essential the use of compatible medications, such as hydroxychloroquine, and constant monitoring by multidisciplinary teams. It is concluded that strict surveillance, combined with patient education and pharmacovigilance, allows the vast majority of pregnant women with rheumatic diseases to achieve a pregnancy with favorable outcomes, reducing rates of preeclampsia and intrauterine growth restriction.(AU)