From preconception care to postpartum support at EULAR 2026: Pregnancy care in RMDs

Dr Vinod Ravindran discusses the advances and ongoing challenges in pregnancy care for women with autoimmune rheumatic diseases.

The European Alliance of Associations for Rheumatology (EULAR) Congress 2026, held in London, UK, from 3–6 June 2026, brought together rheumatology experts from around the world to discuss the latest advances in research and clinical care.

In this Q&A, Editorial Board Member Dr Vinod Ravindran (Centre for Rheumatology, Kozhikode, Keralam, India), shares his key takeaways from the meeting, with a particular focus on reproductive rheumatology and pregnancy care in women with rheumatic diseases. He reflects on progress in preconception, pregnancy and postpartum care, the importance of multidisciplinary support, and the challenges posed by gaps in awareness, access to specialist services and research. Dr Ravindran also highlights the value of international collaboration and networking opportunities at EULAR 2026.

touchIMMUNOLOGY coverage of EULAR 2026

I’m Dr Vinod Ravindran, I’m a consultant rheumatologist based at Kozhikode, Keralam in India. I have a keen interest in reproductive rheumatology. I am the convener of the Indian Rheumatology Association’s Special Interest Group (SIG) on Reproductive Rheumatology and Co-convener of the Asia Pacific League of Associations for Rheumatology (APLAR)’s SIG for Women’s Health & Reproductive Issues in Rheumatic Diseases.

What were your personal highlights from this year’s conference?

There were several sessions and abstract presentations on reproductive rheumatology. A plenary lecture on reproductive care in patients who have rheumatic musculoskeletal diseases by Prof. Laura Andreoli was particularly interesting and informative.

What did you learn about the current status of care in this area?

Women are more predisposed to many autoimmune rheumatic diseases. As such, rheumatologists frequently have to care for women who are planning to become pregnant. The management of women with rheumatic diseases who are planning a pregnancy or who have become pregnant is particularly challenging. It requires not only careful pregnancy planning with the appropriate pregnancy safe medications and ensuring that disease activity is well controlled, but also regular review of these aspects throughout pregnancy and after birth, when breastfeeding begins.

Though our knowledge in this area has evolved considerably over the last 10–15 years, there remain many unmet needs, particularly depending on where one is based. This may also be due to a lack of access to structured rheumatology care that focuses on reproductive rheumatology. In addition, knowledge and awareness of which medications to use in this population are important. To summarize, we are at a far better stage than we were 10 years ago, but there is still a lot of work to be done in this area.

In this context, Prof. Andreoli’s plenary lecture comprehensively covered the entire journey of women with rheumatic diseases, from preconception care through pregnancy and the postpartum period. This includes a thorough assessment of disease activity, ensuring that women are receiving pregnancy-safe medications and appropriate counselling. It is also important to have an open dialogue with women and their partners about potential challenges and how these may be managed.

During pregnancy, disease activity should be kept under control with appropriate pregnancy-safe medications, and there should be a plan in place to manage any disease flares. Postpartum care should take into account the mother’s wishes regarding breastfeeding, with the use of breastfeeding-compatible medications where appropriate, while also ensuring that the infant receives the necessary vaccinations and support.

This was a particularly important plenary, as Professor Andreoli also discussed the 2024 update to the EULAR recommendations on the use of anti-rheumatic drugs in the management of pregnancy in women with rheumatic diseases.

What challenges in managing rheumatic diseases stood out during the sessions?

In terms of current challenges in this area, one of the main issues is lack of awareness, which exists at multiple levels. This includes clinicians and other healthcare professionals, regarding the optimal management of pregnancy and use of pregnancy compatible medications. A second key challenge is limited access to dedicated clinics for managing pregnancy in these patients, as well as a general lack of multidisciplinary care.

From a research perspective, a major challenge is the lack of prospective registries in this field. This makes it difficult to move research forward, as such registries need to run over a reasonable length of time before they generate useful information. Much of the current evidence is based on retrospective studies or analyses of databases that were not specifically designed for this purpose, leading to missing information, including details of the disease and its activity, medication use and reasons for starting or stopping specific medicines.

Overall, the main challenges are a combination of limited awareness and knowledge, lack of multidisciplinary care, restricted access to dedicated services, and insufficient robust research.

Which areas of research or care need the most attention moving forward?

Traditionally, pregnancy outcomes in lupus have received considerable attention, whereas data on pregnancy-related outcomes in other rheumatic diseases, such as rheumatoid arthritis, Sjögren’s disease, and ankylosing spondylitis, remain limited. This remains an important area for future research.

A further challenge is the difficulty in comparing data generated in different healthcare settings, particularly between high-resource settings and regions with more heterogeneous healthcare infrastructure, such as India. Without multi-centric international registries and studies, it is difficult to generate broadly applicable and meaningful data. Therefore, at the level of guideline development, this is an important consideration to ensure that recommendations can be applied across different healthcare systems. To mitigate some of these limitations and address the Asia-Pacific region’s specific needs, the APLAR Consensus Statements for the Management of Reproductive Issues in Autoimmune Rheumatic Diseases have been developed, which I presented at the EULAR-ReHFaP session at this EULAR congress.

Finally, gaps in knowledge and awareness remain a major challenge, although individual societies are actively working to address this among healthcare professionals and other stakeholders.

What networking opportunities were available at the conference?

EULAR congress has always been great as far as this aspect is concerned, as you have a lot of networking opportunities available. There are multiple avenues to meet leaders in the field and other colleagues who are interested in the same area. It is also great to explore the abstract presentations and meet the trainees and clinicians who are presenting their work. One can engage with them, generate ideas and explore collaboration.