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The immune system undergoes changes during pregnancy that can precipitate adverse health outcomes among people with immunologic dysfunction at baseline\u2014particularly those people who have active inflammatory disease at the time of and\/or during pregnancy. However, in this commentary, we challenge the notion that immunologic and disease\u2010centric aspects of pregnancy are the only drivers of adverse pregnancy and perinatal outcomes among people with SARDs. A focus on disease may have limited focus on other factors that could enhance reproductive health outcomes among people with SARDs, for example, the provision of high\u2010quality sexual and reproductive health (SRH) care in the rheumatology context. Identification of such upstream factors can reveal approaches that enhance downstream reproductive outcomes for all women with rheumatic diseases, thereby enhancing person centeredness, holistic care, and SRH equity in rheumatology care. 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