Features of Pregnancy in Chronic Diseases
Pregnancy is a period of significant physiological changes in a woman's body that can affect the course of chronic diseases and, in turn, create unique clinical challenges [5, 6]. Managing the health of the expectant mother, especially in the presence of comorbidities, requires careful planning and an interdisciplinary approach. Active disease status a few months prior to conception significantly increases the risk of flare-ups during pregnancy, which can lead to adverse outcomes for both mother and fetus [3].
Rheumatic Diseases and Pregnancy
Rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and obstetric antiphospholipid syndrome (APS) frequently affect women of childbearing age [1, 2, 3]. Pregnancy in such patients requires special attention. Women with RA and SLE may experience disease flares during gestation, increasing the risk of various complications, including preeclampsia, small-for-gestational-age newborns, and preterm delivery [1, 2].
A key aspect is achieving disease control prior to conception [1, 2, 3]. Women with obstetric APS require anticoagulant therapy throughout pregnancy [1, 2]. It is important to note that many, but not all, antirheumatic drugs are safe for use during pregnancy and lactation [1, 2]. Understanding the impact of pregnancy on disease activity is crucial for patient counseling [3].
Neurological Aspects and Headaches
Physiological changes occurring during pregnancy can affect the nervous system [6]. Neurologists must account for these changes as well as the safety and metabolism of medications when treating chronic neurological conditions such as migraine or epilepsy [6].
Migraine without aura is a common issue. In some cases, such as the use of galcanezumab for migraine prevention, clinical trials have demonstrated its efficacy and safety in animal studies, yet safety data in pregnant women remain limited [4]. Nevertheless, there are reports of normal deliveries without complications for the mother or child following galcanezumab exposure in the first and second trimesters of pregnancy [4]. Hormonal fluctuations associated with IVF procedures can also trigger or exacerbate migraine attacks, sometimes leading to rare complications such as cytotoxic lesions of the corpus callosum [8].
Impact on the Cardiovascular and Visual Systems
Pregnancy significantly increases the hemodynamic load on the maternal cardiovascular system [7]. Many women experience symptoms such as fatigue, shortness of breath, lower extremity edema, and decreased exercise tolerance, which can complicate differentiation from signs of cardiac dysfunction [7]. Acute myocardial infarction during pregnancy is rare, but its incidence is rising and it is associated with significant maternal and neonatal morbidity and mortality. Particular attention is required regarding the causes, diagnosis, and management plan for myocardial infarction in pregnant women [7].
The visual system may also undergo changes. Pregnancy can exacerbate pre-existing eye conditions such as diabetic retinopathy or central serous retinopathy [5]. Furthermore, pregnancy-related systemic conditions can cause acute ophthalmic disorders affecting the retina and choroid. Collaboration between ophthalmologists, obstetricians, and general practitioners plays a key role in managing such complex conditions [5].
Comprehensive approach to health during pregnancy
Given the variety of physiological and pathological changes that can occur during pregnancy, an integrated approach to patient management is essential. This includes careful pregnancy planning, control of chronic conditions before conception, regular monitoring, and timely therapy adjustment [1, 2, 3, 6]. Special attention should be paid to the prescription of medications and the selection of diagnostic or therapeutic techniques to ensure safety for both mother and fetus [5, 6]. Preventing infectious diseases is also an important part of comprehensive care, although specific details on individual infections are not provided in these sources.
Sources
- [1] Pregnancy and management of women with rheumatoid arthritis, systemic lupus erythematosus, and obstetric antiphospholipid syndrome. https://pubmed.ncbi.nlm.nih.gov/35400376/
- [2] Pregnancy and management of women with rheumatoid arthritis, systemic lupus erythematosus, and obstetric antiphospholipid syndrome. https://pubmed.ncbi.nlm.nih.gov/33589107/
- [3] The course of rheumatic diseases during pregnancy. https://pubmed.ncbi.nlm.nih.gov/31507122/
- [4] Normal delivery after galcanezumab exposure until the first and second trimesters of pregnancy: a report of 2 cases. https://pubmed.ncbi.nlm.nih.gov/41760025/
- [5] Physiological and pathological effects of pregnancy on the human visual system. https://pubmed.ncbi.nlm.nih.gov/31190583/
- [6] Neurology of pregnancy: a case-oriented review. https://pubmed.ncbi.nlm.nih.gov/27445250/
- [7] Acute myocardial infarction in pregnancy: an interdisciplinary approach. https://pubmed.ncbi.nlm.nih.gov/41602515/
- [8] Cytotoxic lesion of the corpus callosum associated with migraine with aura induced by in vitro fertilization and embryo transfer: a case report. https://pubmed.ncbi.nlm.nih.gov/40677431/
The information in this article is for reference purposes only and is not intended for self-diagnosis or self-treatment. Always consult a qualified medical professional for an accurate diagnosis and an individualized treatment plan.