Pregnancy can create a challenge for physicians caring for women with rheumatic 
diseases. For many women with rheumatoid arthritis (RA), pregnancy can provide a 
reprieve from long-term joint pain and inflammation, but others will not 
experience remission and will continue to need medication. Systemic lupus 
erythematosus (SLE) may remain quiet in some women, but in others may become 
more aggressive during pregnancy, putting both mother and foetus at risk. Women 
with limited scleroderma can do remarkably well, but scleroderma renal crises 
can be difficult to manage. A third of pregnancies in women with 
antiphospholipid syndrome (APS) may be refractory to our best therapy. In 
general, active inflammation from rheumatic diseases poses a stronger threat to 
the well-being of both mother and foetus than many immunosuppressant 
medications. Therefore, continued immunosuppression with the least risky 
medications will allow for the most optimal pregnancy outcomes.