It was a great academic experience to attend the 13th International Conference on Reproduction, Pregnancy and Rheumatic Diseases (RheumaPreg 2025) held in Vienna, Austria, from 8–10 May 2025 as an invited faculty. This interdisciplinary meeting of rheumatologists, obstetricians, intensivists, neonatologists, pathologists, allied health professionals, and patient representatives had over 400 delegates from 46 countries. The cutting-edge discussions and presentations covered all aspects of pregnancy and its management in the context of autoimmune rheumatic diseases (AIRDs), ranging from pre-pregnancy counselling, contraception, conception, assisted reproduction, pregnancy, postpartum period, and lactation. Specific challenges in the management of AIRDs, such as lupus and antiphospholipid syndrome, were deliberated upon, while several updates on pregnancy-safe anti-rheumatic drugs were presented. Here are my highlights from this focused meeting.
In a session on the “Challenges of fertility in the context of rheumatic diseases and social changes”, Dr Klara Rosta (Vienna, Austria) discussed several specific factors affecting the ovarian function of patients with AIRDs. They included chronic inflammation, gonadotoxic medications, glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs), specific autoantibodies and increased prolactin production seen in a lupus flare. In this context, hormonal imbalance, autoimmune oophoritis and hypothalamic-pituitary-ovarian (HPO) axis dysfunction also played a part. Due to these adverse factors, women with AIRDS may experience menstrual irregularity, ovarian dysfunction, diminished ovarian reserve and premature ovarian failure. This discussion highlighted that focusing on disease-related aspects alone may not be sufficient and that a more holistic approach would be required.
In a session on “Navigating Pregnancy with SLE: Challenges and innovations”, Dr Ian Giles (London, UK) advocated for ‘4 D’s’ regarding choosing medications for women with lupus; Discuss- planning and managing pregnancy and breast feeding; Damage- consider pre-existing co-morbidities; Disease activity- maintain control; Drug safety- continue compatible medication. His talk also discussed the usage of monoclonal antibodies, cyclophosphamide, or mycophenolate in pregnant women with lupus and severe maternal disease during the second or third trimester, when no other pregnancy-compatible drugs were suitable. In the scenarios of accidental pregnancy whilst on pregnancy-‘unsafe’ drugs, he suggested a framework comprising reassuring the patient, seeking local advice, evaluating risk, and to continue treating the mother, bearing in mind that there are no diseases or drugs where the risk is absolute. In a further session on “Immunosuppression during pregnancy”, Dr Giles discussed how in severe refractory maternal disease, there are several options including methylprednisolone pulses, intravenous immunoglobulins, conventional or biological disease-modifying drugs, and sildenafil depending on the underlying disease and specific manifestations.
In a subsequent session on “Long-term postpartum challenges”, Dr Laura Andreoli (Brescia, Italy) addressed the long-term follow-up of children born to mothers with AIRDs. She emphasized several contributing factors which may lead to potential long-term effects in these children, including underlying diseases and their pathogenetic mechanisms, the use of immunomodulatory drugs, and certain antibodies. Long-term effects included the development of AIRDs, neurodevelopmental disorders (linked to preterm birth), early cardiovascular and/or metabolic disorders (associated with extreme preterm birth), reduced response to vaccinations, and an increased risk of serious infections.
In a debate on “Immunomodulation for recurrent implantation failure and miscarriages”, Dr Arsene Mekinian (Paris, France) emphasized that neonatal immune ontogeny begins during pregnancy, ensuring that the neonate is well suited for perinatal life. Both recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) share a common basis in maternal-fetal intolerance. The decidua functions as a biosensor for embryonic quality control, and an unfit embryo is unable to complete organogenesis in the hypoxic environment or withstand the oxidative stress triggered by the onset of placental blood supply. As most of the immune pathophysiology in RPL and RIF is endometrium, placenta, or embryo-based, immunomodulation is not recommended except in women who have autoimmune conditions such as lupus, autoimmune thyroiditis, coeliac disease, and inflammatory bowel diseases.
Looking forward to RheumaPreg2027 in Rotterdam, the Netherlands!
Further content in rheumatic diseases.
Editor: Victoria Jones, Senior Content Editor.
Disclosures: This short article was prepared by touchIMMUNOLOGY in collaboration with Dr. Vinod Ravindran. touchIMMUNOLOGY utilize AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. No fees or funding were associated with its publication.
Cite: Vinod Ravindran. RheumaPreg 2025: Dr. Vinod Ravindran’s Perspectives and Highlights. touchIMMUNOLOGY. 19 May 2025.
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