Background Pregnancy is considered to be an important factor that may affect the course of autoimmune diseases; few data are currently available in the literature on pregnant patients with diagnosis of undifferentiated connective tissue disease (UCTD).
Objectives To assess the outcome of pregnancy and evaluate the percentage of disease flare in a cohort of patients with UCTD.
Methods We conducted a prospective study on 78 pregnancies in 64 UCTD patients, regularly monitored from the positive pregnancy test until the postpartum period by a multidisciplinary team including rheumatologists and obstetricians at our unit from 2000 to 2015.
Results The mean age of patients at pregnancy was 34.1 (range 21–43) and the mean disease duration was 7.26 years. Only 3 patients presented hematologic disease activity at the beginning of pregnancy and none of the patients had experienced previous renal involvement. 20.8% of UCTD patients presented antiphospholipid (aPL)-antibodies positivity (only 2 cases of triple positivity of LAC, anti-β2GPI and ACLA) and the same percentage had anti-Ro positivity. At the beginning of pregnancy 38.5% of patients was taking treatment: 20 hydroxychloroquine, 13 low doses of steroids and 11 aspirin. On average, the duration of pregnancy was 39 weeks (range 34–42), the mean birth weight was 3118.3 g (range 2122–4500 g). Eight pregnancies (10.5%) ended in miscarriage in the first trimester; the following obstetric complications occurred in 34.7% of the remaining successful deliveries: preterm delivery, small or large for gestational age (SGA/LGA), preeclampsia, premature membrane ruptures (PROM), increased transaminases. Six patients experienced a disease flare, 3 during pregnancy and 3 in puerperium: of these patients, 3 had a major flare progressing to SLE with the occurrence of lupus nephritis. No correlations were found between the incidence of obstetric complications and the positivity of aPL-antibodies, the use of steroids, the alterations of uterine artery Doppler velocimetry. The only variable correlated with the incidence of flare was the positivity of anti ds-DNA at the beginning of the pregnancy (p<0.001).
Conclusions Our data suggest that UCTD as other connective tissue diseases should be carefully monitored during pregnancy as these patients present with obstetric complications. As in non pregnant UCTD patients anti-dsDNA are predictors of possible evolution to SLE, therefore these patients need careful monitoring during pregnancy.
Disclosure of Interest None declared