Establishing a Consultation Service for Women with Inflammatory Rheumatic and Musculoskeletal Diseases during Preconception, Pregnancy, and Lactation: Analysis of the purpose of consultation

Background: Women with inflammatory rheumatic and musculoskeletal disease (iRMD) face unique challenges during preconception, pregnancy, and lactation. In 2024, the tertiaryRheumatology Center Ruhrgebiet, established a specialized consultation service to address these needs, provide a descriptive analysis and prepare a longitudinal cohort. Methods: Demographic information, disease- and treatment related data, reproductive status, referring physician, reasons for consultation, and disease management recommendations were collected during 01.01.2024 and 03.04.2025. Continuous variables are reported as mean± standard deviation (SD), categorical variables as absolute numbers and percentages. Results: Overall 57 patients were included, mean age was 33.3± 4.4 years and the mean disease duration 6.3± 4.8 years. Almost all patients (94.7%) had confirmed diagnosis of iRMD. 57.9% were planning pregnancy, 40.4% were pregnant, and 1.8% were breastfeeding. At baseline, 21.8% were receiving csDMARDs, 54.4% bDMARDs. Glucocorticoid use was documented in 16.1%. Patients were referred from rheumatologists (35.7%), in-house outpatient clinic (37,5%), general practitioners (14.3%), gynaecologists (10.7%), and in-house inpatient care (1.8%). The most frequent reasons for consultation were patient concerns regarding pregnancy and medication safety. There were significant differences in the consultation reasons between preconception and pregnancy status of the patient. Consultation service include modification of DMARD therapy (35.1%), initiation of fetal bradycardia screening (19.3%), and preeclampsia prophylaxis (8.8%). Conclusion: The establishment of a dedicated consultation service for women with iRMD supports women in preconception, pregnancy, and lactation care. This analysis shows medication adjustments and targeted preventive measures especially in pregnancy in more than one third of the patients, which shows the importance of an early referral.