A clinical care pathway for managing pregnancy in patients with inflammatory arthritis

Inflammatory arthritis (IA) disproportionately affects women and is particularly concerning in those of childbearing age, where unique considerations are required in their management. Existing practice guidelines provide recommendations on managing IA before, during, and after pregnancy. However, there is a lack of Canadian clinical resources to support shared decision-making between clinicians and patients with IA. A comprehensive care plan for women of childbearing age with IA should include preconception counselling, a 40-week pregnancy plan, and postpartum care. Preconception counselling should address contraception to reduce the risk of unplanned pregnancy, as well as the bidirectional impact of disease on pregnancy outcomes. The 40-week pregnancy plan includes monitoring disease activity, assessing medication safety, and planning delivery. The postpartum care plan should emphasize medication management, particularly in the context of breastfeeding and vaccinations for infants exposed to biologic medications in utero. The goal of this clinical care pathway is to provide a resource for managing patients with IA who are contemplating pregnancy, are pregnant, or are in the postpartum period. Key Points • Managing women of childbearing age with inflammatory arthritis (IA) requires a unique set of considerations. • There is a lack of Canadian clinical resources to guide the management of women of childbearing age with IA. • This clinical care pathway is intended as a resource for multidisciplinary teams managing patients with IA who are contemplating pregnancy, are pregnant, or are in the postpartum period. • The proposed care pathway includes preconception counselling, a 40-week pregnancy plan, and postpartum care for women of childbearing age with IA.