Objective To define efficacy of consultation before and during pregnancy on therapeutic adherence in a single-center cohort of patients with rheumatic diseases.

Methods A web-based survey was administered to a cohort of patients with a rheumatic disease having had at least one pregnancy. Items investigated included therapy during pregnancy, reduction or discontinuation of therapy without medical consultation and patients‘ perceptions about counselling before and during pregnancy. Clinical data were collected for further analysis.

Result 71 patients diagnosed with rheumatic disease having had a pregnancy between 1996 and 2023 participated. Mean age at conception of the last pregnancy was 34±1.0 years, mean disease duration at conception was 11.2±6.4 years. Participants’ rheumatic diseases included SLE (n=43;60.5%), Sjogren’s syndrome (n=6;8,5%), UCTD (n=8;5%), psoriatic arthritis (n=3;4.2%), juvenile arthritis (n=3;4.2%), rheumatoid arthritis (n=3;4,2%), vasculitis (n=3;4,2%), spondylarthritis (n=1;1.4%) and myositis (n=1;1.4%).

Therapies taken at the time of conception included prednisone (n=20;28.2%), hydroxychloroquine (n=48;67.6%) and immunosuppressant (n=25;35.2%) of which mostly biologic drugs (n=16.9%) and azathioprine (n=11;15.5%). Therapies taken during pregnancy included hydroxychloroquine (n=50;70.4%), prednisone (n=20;28.2%), azathioprine (n=12;16.9%) and biologic drugs (n=6;8.4%). 68 patients (95.8%) declared full adherence to the prescribed therapy; 3 (4.2%) reported lowering the dosage of therapy during pregnancy without medical consultation; 1 (1.4%) reported discontinuing the medication. The given reasons were the feeling of wellness regarding their rheumatic disease and the fear of side effects for themselves and the fetus. 69 patients (97.2%) reported receiving adequate preconception counselling. All patients reported satisfaction with the counselling received during pregnancy. The children of the patients examined by the cohort were all healthy at the time of birth.

Conclusions Almost the whole cohort, the majority of whom were patients diagnosed with SLE, reported receiving an adequate counselling, in both the preconception and pregnancy phases, and declared complete adherence to therapy. The very few cases of poor adherence were related to a perception of inadequate preconception counselling (less than 3% of the entire cohort) and fear of side effects of drugs on maternal and foetal health. The effectiveness of appropriate counselling before and during pregnancy can be demonstrated by the high level of therapeutic adherence, which is essential in avoiding disease-related maternal-foetal complications, as shown by our cohort. A limitation of this study was the impossibility of having a control group, i.e. patients not receiving counselling in the preconception phase and during pregnancy, also due to ethical reasons.