ORIGINAL ARTICLE A multidisciplinary approach to reproductive healthcare in women with rheumatic disease Kieran Murray 1 & Louise Moore 2 & Celine O’Brien 3 & Anne Clohessy 3 & Caroline Brophy 3 & Oliver FitzGerald 1,2 & Eamonn S. Molloy 1,2 & Anne-Barbara Mongey 1,2 & Shane Higgins 3 & Mary F. Higgins 3 & Patricia Minnock 1,2 & Joan Lalor 4 & Fionnuala M. McAuliffe 3 & Douglas James Veale 1,2 Received: 3 April 2019 /Accepted: 17 May 2019 # Royal Academy of Medicine in Ireland 2019 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 medi- cations. 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. Keywords Biologic . Pregnancy . Psoriatic arthritis . Rheumatoid arthritis Introduction Good control of rheumatic diseases (RDs) prior to conception is essential for disease remission for the mother, a safe pregnancy and delivery of a healthy baby [1–4]. A multidis- ciplinary approach to pregnancy care has been advocated to ensure best possible outcomes for mother and baby [4–6]. Symptomatic relief and RD control are usually achieved and maintained by judicious use of steroids, non-steroidal anti- inflammatory drugs (NSAIDS), and disease-modifying anti- rheumatic drugs (DMARDs) including conventional (e.g. methotrexate) and biologic pharmacotherapies. These medications can have potentially serious adverse effects. Therefore, the need to prescribe these medications for women of reproductive age, considering family planning, poses a dilemma [3, 7]. It is important that women taking specific medications, e.g. methotrexate, do not conceive on treatment. Thus, clear advice on effective contraception is critical. For pregnant women with RD experiencing a disease flare, timely intervention with appropriate treatment is imper- ative as active disease can negatively affect pregnancy out- comes [8]. Some of the advice on the compatibility of Louise Moore and Kieran Murray both contributed equally to this paper and are co-first authors. * Kieran Murray kemurray@hotmail.com 1 Rheumatology Department, University College Dublin and St. Vincent’ s University Hospital, Elm Park, Dublin 4, Ireland 2 Rheumatology Department, Our Lady’ s Hospice and Care Services, Harold’ s Cross, Dublin 6W, Ireland 3 UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland 4 Trinity College, Dublin 2, Ireland Irish Journal of Medical Science (1971 -) https://doi.org/10.1007/s11845-019-02040-5