At Last! Reproductive Guidelines for Rheumatologists

It was not until 2020 that reproductive health finally got the careful consideration it needed in the rheumatic and musculoskeletal diseases. The American College of Rheumatology released is guidelines for the management of reproductive health. Here, Mariah Z Leach, founder of Mamas Facing Forward, a support group for mothers with chronic illness, tells us why it is so needed.

Here’s Mariah…

Due to everything that has been going on in the world recently, I am rather behind in sharing this exciting news – but that does not diminish the importance of this development!

In February, the American College of Rheumatology released its first-ever guideline on managing the reproductive health of patients with rheumatic diseases. This means, for the first time ever, rheumatology healthcare professionals have an official set of evidence-based clinical practice guidelines to turn to when deciding how to counsel patients who are or wish to become pregnant.


The guidelines provide vital background knowledge, recommendations for reproductive health issues, and additional information for diagnoses where pregnancy is considered more complicated, such as systematic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).

The recommendations are separated into six categories:

  • Contraception
  • Assisted Reproductive Technology (Fertility Therapies)
  • Fertility Preservation
  • Pregnancy Assessment and Management
  • Menopause and Hormone Replacement Therapy
  • Medication Use (Paternal and Maternal)


So what does this mean for rheumatology patients? Well, I’ve interacted with many women living with rheumatic diseases who are or want to become mothers as I worked to develop first the private Mamas Facing Forward Facebook group and then this website. Over and over (and over and over) I’ve heard stories from patients whose doctors didn’t know anything about how reproductive health issues intersected with rheumatology issues, or whose doctors gave them information that conflicted with information from the OB/GYN, or whose doctors flat out gave them incorrect information, bad advice, or refused to look at updated research.

My hope is that these official guidelines will help get rheumatology healthcare professionals up to speed with the latest research concerning pregnancy and breastfeeding with rheumatic diseases. It would be amazing if these official guidelines could encourage rheumatology healthcare professionals to support their patients who want to get pregnant or breastfeed their babies. And in the cases where doctors are still uninformed? I’m glad that patients now have an official resource they can pass along to their doctors.

My hope is that these official guidelines will lead to far better pregnancy and breastfeeding experiences than those experienced by many mamas who came before. And improvement is exciting!

Mariah LeachMariah is a writer, healthcare advocate, and mom of three living with rheumatoid arthritis. After learning firsthand the challenges of facing pregnancy and motherhood with a chronic illness, Mariah has become passionate about supporting women with chronic illnesses who are or want to become mothers. She launched Mamas Facing Forward in 2015.

From the Editor:

Patients Rising expresses its thanks to Mamas Facing Forward and Mariah Leach for sharing this content. It can be found in its original form on Mamas Facing Forward).

Mariah lives with rheumatoid arthritis, a topic we have published about before if you are interested in reading more:

My Life With Juvenile Rheumatoid Arthritis – by Zoe Walsh

And to better understand why this evolution in rheumotology is so important, consider reading:

What is “Access to Care”? – by Patients Rising

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