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FRI0490 Infertility and Pregnancy in Rheumatic Diseases: The Utility of A Multidisciplinary Protocol for The Management of These Patients
  1. I.C. Chalmeta1,
  2. J. Ivorra1,
  3. B. Marcos2,
  4. C. Diaz3,
  5. E. Beltran4,
  6. R. Negueroles1,
  7. J.L. Valero1,
  8. C. Feced1,
  9. F. Ortiz1,
  10. L. Gonazlez1,
  11. I. Martinez1,
  12. E. Labrador1,
  13. K. Arevalo1,
  14. E. Grau1,
  15. C. Alcañiz1,
  16. J. Fragio5,
  17. J. Roman1,6
  1. 1Rheumatology
  2. 2Gynecologist&Obstretics
  3. 3Fertility Unit, Hospital la Fe
  4. 4Hospital General
  5. 5Hospital la Fe
  6. 6Rheumatology, Universidad Catόlica Valencia, Valencia, Spain

Abstract

Background Pregnancy in rheumatic diseases is a process that requires careful handling, beginning with proper planning. Infertility and chronic use of teratogenic drugs are some common situations in these patients, giving them a high-risk obstetrics.

Objectives To established a protocol for planning and monitoring pregnancies in patients with rheumatic diseases

Methods Retrospective review of a follow-up protocol for patients with rheumatic diseases and pregnancy wishes. This protocol includes: preconception consultation to asses fertility of the couple, as well as pregnancy couselling and establishment of a appropriate pharmacological treatment; after pregnancy period start, monthly consultations by a multidisciplinary team; and finally, a postpartum consultation after delivery

Results A total of 51 patient with different rheumatic diseases were included: Sistemic Lupus Erythematosus (8 patients), Sjogren'S Syndrom (10 patients), Rheumatoid arthritis (13 patients), Psoriatic arthritis (5 patients), Behcet's disease (3 patients), Spondiloarthritis (2 patients), Familial Mediterranean Fever (2 patients), Conective mixed Tissues Disease (1 patient), Primary Antiphospholipi Syndrom (2 patient) an Hyper IgD Syndrome (1 patient). The results were: Infertility was detected in 8 couples and assisted reproductive techniques was requieres in 7 (6 IVF and 1 insemination). Safe Pharmacological treatments were used: sulfasalazine (4), hydroxychloroquine (13), azathioprine (2). Biological DMARDs in 3 patients (1 infliximab and Certlizumab in 2). Other treatments were: steroids (12) and intravenosus immunoglobulins for fetal heart block (2). All patients with thrombophilia have been treated with LMWH alone or plus aspirin. The course of pregnancy was:delivery at term (28), delivery pre-term (3)**, miscariages (3)*, pregnancy on course (7), neonatal death (1) and 8 patients are plannig the pregnancy. The abortions have occurred in 2 patients with lupus erythematosus and in 1 patient with rheumatoid arthritis. Postpartum care of newborns with mothers with positivity anti-Ro has objectified a neonatal transfer of Acs in 100% of cases;only 8 of them developed neonatal SLE.

Conclusions A satisfactory evolution of pregnancy was observed in 87% of our patients, a fact that supports our impression that this process should be approached in a multidisciplinary team. Infertility is a situation that should be considered and treated at an early stage in this patients, preferably before preconceptional period.

Disclosure of Interest None declared

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