Background Pregnancy and delivery are important life events for women. Recently, many connective tissue disease (CTD) patients have desired to become pregnant because of improved prognosis by early diagnosis and long-term remission under treatment with immunosuppressants. However, pregnancy in CTD patients is often associated with problems, including underlying disease exacerbation, complications of miscarriage and preterm birth, and light for dates (LFD) in the peripartum period. Whether these problems are associated with the activity of underlying disease or treatment with immunosuppressants is unclear.
Objectives We analyzed the relationship between miscarriage, preterm birth, LFD, perinatal complications, and change in disease activity or dose of corticosteroid during pregnancy in our facility.
Methods We retrospectively examined exacerbation of underlying disease, mode of delivery, rate of miscarriage and prematurity, neonatal birth weight, complications (e.g., threatened premature delivery and pregnancy-induced hypertension), and the dose of corticosteroid treatment during pregnancy for 8 years from October, 2006 to October, 2013. We also measured anti-SS-A antibody and antiphospholipid antibody.
Results Sixty-three patients (77 pregnancies) who delivered at our institute were enrolled. At the time of pregnancy, the mean age was 31.9 years old and the mean disease duration was 7.1 years. Underlying diseases were as follows: systemic lupus erythematosus (32%), Sjögren syndrome (SS 28%), antiphospholipid syndrome (6%), and rheumatoid arthritis (16%). The activity of CTD was exacerbated in nine patients (11.3%) during pregnancy, and six required a high dose of corticosteroid therapy because of flare-up of CTD activity. Anti-SS-A antibody was positive in 35 cases (45.4%). However, there were no cardiac events and/or dermatological manifestations in newborns related to its antibody. Antiphospholipid antibody was positive in 19 cases (24.6%), and only one patient had a preterm birth considered as associated with its antibody. The rate of miscarriage was 7.7% and the rate of preterm birth was 17%. The rate of preterm birth was higher than normal (8%). The reason for preterm birth in all cases was termination of pregnancy dependent on flare-up of underlying CTD activity but on fetal problem. There was no relationship between the dose of corticosteroid and preterm complications, including preterm birth (13 cases), LFD (6 cases) or others (29 cases). We were able to safely increase the dose of corticosteroid for the treatment of underlying CTD during pregnancy in these patients.
Conclusions In pregnancy complicated by CTD, preterm birth, LFD, and complications are strongly associated with the activity of underlying disease. Corticosteroids are not related to complications and can be safely used during pregnancy. Taken together, we need to strictly manage underlying disease with corticosteroids for pregnancy and delivery complicated by CTD.
Disclosure of Interest None declared
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