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Prevalence and significance of previously undiagnosed rheumatic diseases in pregnancy
  1. Arsenio Spinillo1,
  2. Fausta Beneventi1,
  3. Véronique Ramoni2,
  4. Roberto Caporali2,
  5. Elena Locatelli1,
  6. Margherita Simonetta1,
  7. Chiara Cavagnoli1,
  8. Claudia Alpini3,
  9. Giulia Albonico3,
  10. Elena Prisco2,
  11. Carlomaurizio Montecucco2
  1. 1Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
  2. 2Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
  3. 3Laboratory Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
  1. Correspondence to Carlomaurizio Montecucco, Divisione di Reumatologia, Piazzale Golgi 2, 27100 Pavia, Italy; montecucco{at}smatteo.pv.it

Abstract

Objectives The objective of this study was to evaluate the rates of previously undiagnosed rheumatic diseases during the first trimester of pregnancy and their impact on the pregnancy outcome.

Methods Pregnant women in their first trimester were screened using a two-step approach using a self-administered 10-item questionnaire and subsequent testing for rheumatic autoantibodies (antinuclear antibody, anti-double-stranded DNA, anti-extractable nuclear antigen, anticardiolipin antibodies, anti-β2-glycoprotein I antibodies and lupus anticoagulant) and evaluation by a rheumatologist. Overall, the complications of pregnancy evaluated included fetal loss, pre-eclampsia, gestational diabetes, fetal growth restriction, delivery at less than 34 weeks, neonatal resuscitation and admission to the neonatal intensive care unit.

Results Out of the 2458 women screened, the authors identified 62 (2.5%) women with previously undiagnosed undifferentiated connective tissue disease (UCTD) and 24 (0.98%) women with previously undiagnosed definite systemic rheumatic disease. The prevalences were seven (0.28%) for systemic lupus erythematosus and Sjogren's syndrome, six (0.24%) for rheumatoid arthritis, three (0.12%) for antiphospholipid syndrome and one (0.04%) for systemic sclerosis. In multiple exact logistic regression, after adjustment for potential confounders, the OR of overall complications of pregnancy were 2.81 (95% CI 1.29 to 6.18) in women with UCTD and 4.57 (95% CI 1.57 to 13.57) in those with definite diseases, respectively, compared with asymptomatic controls.

Conclusions In our population approximately 2.5% and 1% of first trimester pregnant women had a previously undiagnosed UCTD and definite systemic rheumatic disease, respectively. These conditions were associated with significant negative effects on the outcome of pregnancy.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the local ethics committee of the Department of Obstetrics and Gynecology.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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