Background Systemic Lupus Erythematosus (SLE), Antiphospholipid Syndrome (APS) and Thrombophilia are associated with considerable pregnancy-related morbidity. Multidisciplinary teams allows the application of an experienced protocol to monitor and treat them during pregnancy in order to reduce adverse pregnancy outcomes and this way improve the prognosis of the pregnancy.
Objectives To investigate pregnancy outcomes in women with rheumatic diseases and thrombophilia from a Spanish cohort.
Methods A population of 93 patients diagnosed with SLE, APS and Thrombophilia atended in a specialized multidisciplinary unit of Rheumatic Diseases and pregnancy from the Complejo Hospitalario Universitario de Granada, Spain from January 2012 to December 2016. The following variables were collected: age, presence of antiphospholipid antibodies and anti Ro, thrombotic episodes and prior abortions, treatment during pregnancy, obstetric outcomes births/abortion and pregnancy length. The statistical analysis was done using the McNemar Test.
Results 93 pregnant women were included in the study. 26 were diagnosed with SLE, 32 with APS and 35 with Thrombophilia (mostly, Heterozygotes for MTHFR gene). 47.3% were younger than 35 years and 52.7% were elder than 35 years. 66.7% had one or more prior abortions, meaning a total record of 159 abortions and an average of 1.71±1.76 abortions per patient. The treatment received by the patients is specified in table 1. 9 patients (3 APS and 6 thrombophilia) received a treatment with intravenous gammaglobulin with doses of 400 mg/kg, apart from Low-Molecular-Weight Heparin (LMWH) and Acetylsalicylic Acid (ASA), two days in a row at the beginning and then every three weeks during the whole pregnancy. 90 (96.8%) pregnancies were developed. 6 of them were preterm pregnancies and 84 were term pregnancies. Only 3 abortions (3.2%) occurred in the patients monitored in our unit. The reduction in the number of abortions was statistically significant (p<0.001). Regarding those 3 registered abortions, 2 were patients diagnosed with SLE, with no records of previous abortions and they occurred during the second trimester of pregnancy. 1 was diagnosed with APS and she had records of 2 previous abortions and occurred during the first trimester of pregnancy. Those patients who received treatment with gammaglobulin iv showed an mean of 4.88±1.85 previous abortions per patient and all had a term delivery (100%).
Conclusions Our results demonstrate a decrease in the number of abortions and a larger number of term pregnancies since the inclusion of patients with high risk pregnancies in our unit. Prophylactic treatment is effective for the prevention of abortions, reaching higher rate live birth pregnancies. The multidisciplinary evaluation is essential to prevent complications in women diagnosed with rheumatic diseases with high obstetric risk.
Disclosure of Interest None declared