Background Multi-disciplinary clinics between obstetricians and rheumatologists are well established in the management of pregnant women with rheumatic diseases. Our monthly high risk clinic (HR-ANC) at the Royal London Hospital, run in conjunction with a haematologist and anaesthetist has run since 2002 and is well established in the management of pregnant women with complex disease within a multi-ethnic setting.
Objectives We present 3 year prospective outcome data for women with both autoimmune connective tissue diseases, predominantly SLE (CTD) and inflammatory arthropathies (IA).
Methods Prospective data was collected for all women with rheumatic diseases who attended the HR-ANC at the Royal London Hospital (2009-2011). Patients with CTD, IA and some mechanical problems attended and were reviewed throughout their pregnancies. Data was collected for ethnic group, diagnosis, number of weeks to be booked to HR-ANC, number of attendances, number and type of interventions, including the use of DMARDs and corticosteroids, physiotherapy and other interventions, such as OT, mode of delivery, gestation at delivery and birth weight.
Results The patients who attended came from a wide ethnic background (48% Asian, 28% Caucasian, 15% Black/Afro-Caribbean, 9% Other/Unspecified. Eighty patients attended in total (CTD = 42, IA = 34, mechanical = 4). No significant differences were found between the groups in outcome as determined by number of clinic attendances, rates and type of intervention, mode of delivery, gestation and birth weight (1 way and 2 way anova). Significant differences were found in the time taken to attend the HR-ANC from booking in the ANC. Patients with CTD took on average 5.6 weeks compared with 10.1 weeks for IA to be seen within the HR-ANC (p= 0.013, unpaired t-test).
Conclusions Our clinic is well established in the management of high risk pregnant patients with a range of rheumatic diseases from a multi-ethnic background. The multi-disciplinary nature of the clinic significantly reduces the number of appointments that women need to attend and allows same day decision making between specialisms. Good communication between our Department of Rheumatology and the ante-natal staff allows the potentially most complicated patients (CTD) to reach specialist care swiftly. No significant differences were found in the majority of outcome data. Our birth weights were comparable to normal. Compared with previously published data for outcomes in pregnant patients with SLE (1), we found no evidence of IUGR, prematurity or increases in interventional delivery. Good outcomes from the SLE/CTD patients may have occurred because the cohort of SLE patients studied had low disease activity scores (LAI-P) during pregnancy (unpublished data), our clinic is well established and/or has close multi-disciplinary monitoring of complex patients.
Julkunen H et al. Fetal outcomes in lupus pregnancy: a retrospective case-control study of 242 pregnancies in 112 patients. Lupus 1993 2(2): 125-131
Disclosure of Interest: None Declared