Maintaining low disease activity during pregnancy using treat-to-target strategies is associated with better maternal and fetal outcomes, a leading European rheumatologist told the EULAR 2026 Congress in London.

Associate Professor Laura Andreoli, from the University of Brescia in Italy, said more than 50 papers on reproductive health in rheumatic and musculoskeletal diseases had been published in the past 12 to 18 months, a sign of rapidly growing interest in the field, but also of how much remained unknown.

“The more we research, the more we uncover our gaps in knowledge and unmet needs for our patients,” she told the congress.

Speaking in a “What’s new in rheumatology” session, Associate Professor Andreoli said evidence from multiple studies showed treat-to-target approaches during pregnancy were associated with high remission rates and low rates of preterm birth in rheumatoid arthritis cohorts.

Biologic therapies, particularly TNF inhibitors, were increasingly accepted during pregnancy, with long-term observational data showing rising continuation rates over time. She acknowledged, however, that patient reluctance to use medication during pregnancy remained a challenge.

“If the mother is unwell, most probably the baby will also be unwell,” she said. “If we need medications that are compatible during pregnancy to keep maternal disease under control, we should consider using them.”

Glucocorticoids remained a concern. Evidence linked oral glucocorticoid use to an increased risk of preterm birth, reinforcing EULAR recommendations to taper to the lowest possible dose and discontinue where feasible.

Associate Professor Andreoli also highlighted the emotional and psychological burden of reproductive decision-making. While physical outcomes had improved, she said mental health outcomes had not kept pace, with patients continuing to report unmet needs around counselling and postpartum support.

She said reproductive care in rheumatology should be viewed as a continuous pathway from preconception through to postpartum health, requiring input from rheumatology, obstetrics, maternal medicine, midwifery and paediatrics.

She pointed to a recently launched Lancet Rheumatology commission aiming to develop an evidence-based, person-centred framework to bridge the gap between research and clinical practice.