ABSTRACT
This chapter covers the autoimmune connective tissue diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), Sjögren’s syndrome and scleroderma. Changes in the immune system in pregnancy result in relatively suppressed cell-mediated immunity and enhanced humoral immunity. Pregnancy is associated with a decrease in T-cell immunity that is reversed postpartum. Paracetamol is safe in pregnancy and may be instituted or continued in maximal doses if required. Corticosteroids are the first-line anti-inflammatory drugs in pregnancy. During pregnancy, systemic lupus erythematosus (SLE) flares are treated with new or increased doses of steroids. Adverse effects on pregnancy relate to the degree of any renal, lung or cardiac involvement. Pre-pregnancy counselling is vital to inform women accurately about the potential risks of pregnancy. In women with scleroderma, there are often problems with blood pressure measurement, venous access, capillary oxygen saturation monitoring and difficult airways.
