Background Rheumatic diseases are prevalent in women of childbearing age who want to have offspring. Hormonal and immunologic changes during pregnancy may influence the course of the inflammatory disease and could carry maternal or fetal complications.
Objectives To describe the characteristics of a cohort of pregnant patients with rheumatic diseases being controlled in a specific consultation of pregnancy.
Methods Descriptive observational study. All patients controlled in this consultation from 2011 to 2015 were included. The following data were collected: age at the conception, diagnosis, treatment during pregnancy, weeks of gestation, type of birth, breastfeeding, complications affecting the mother and the fetus, and autoantibodies profile (antinuclear antibodies (ANA), anti-Ro, anti-La and antiphospholipid antibodies [aPL]). Statistical analysis was done using SPSS 17.0.
Results Twenty-five patients having Rheumatoid Arthritis [RA] (4), Psoriatic arthritis [PsA] (2), Ankylosing spondylitis [AS] (4) (two associated with Crohn's disease [CD]), Palindromic rheumatism (1), chronic oligoarthritis (1), Systemic Lupus Erythematosus [SLE] (6) (2 having antiphospholipid syndrome (APS) and 1 showing anti-Ro and aPL), APS (1), Behcet's disease [BD] (2); Systemic Sclerosis [SSc] (1); Sjögren's Syndrome [SS] (1); Mixed connective tissue disease [MCTD] (1) and psoriasis [Ps] plus ANA, anti-Ro and anti-La antibodies (1) were studied. All the patients were in remission or low disease activity.
The mean age of the patients was 33.32±3.7 years, mean pregnancy duration was 38.5±2.2 weeks and 24% of the patients had two pregnancies during the follow-up period. Thirty-one pregnancies were recorded. 93.6% were term pregnancies (75.9% vaginal delivery, 24.1% caesarean). Two patients had a miscarriage at 8 weeks. Regarding previous abortions, 2 were reported in APS, 2 in BD, 1 in MCTD, 7 in CD-AS and 2 in RA patients. 64.5% of the patients chose breastfeeding. No hypertension, eclampsia, pre-eclampsia or thrombosis were observed as maternal complications. As for fetal complications, intrauterine growth restriction (16.1%) and fetal distress (12.9%) occurred in mothers with anti-Ro antibodies and in one RA patient. A patient having Ps and anti-Ro antibodies reported a case of fetal heart block in their 1st pregnancy, but she had a second pregnancy with no complications. A case of neonatal lupus without cardiac affection was recorded in a SS patient.
No treatment was needed during pregnancy in 22.6% of the patients. Patients having SLE, SS and MCTD had antimalarial drugs (along with salicylic acid and heparin in case of APS). Sulfasalazine and antimalarials were used in patients with inflammatory arthritis. Adalimumab and azathioprine (AZA) were maintained until week 30th in a CD-AS patient. AZA was also used in a BD patient. 25.8% needed low-dose corticosteroids.
Conclusions Our results confirm that optimal treatment of diseases, before conception and during pregnancy, minimize complications during and after pregnancy. Patients having anti-Ro and aPL have higher frequency of complications. Better results can be achieved by means of the creation of specific pregnancy consultations.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.