Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospectiveItalian P-RHEUM.it study
Articolo
Data di Pubblicazione:
2024
Abstract:
Objectives: To investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it.
Methods: Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018-2023). Maternal and infant information were collected in a web-based database.
Results: We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress.
Conclusions: Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures.
Methods: Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018-2023). Maternal and infant information were collected in a web-based database.
Results: We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress.
Conclusions: Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures.
Tipologia CRIS:
1.1 Articolo in rivista
Keywords:
antirheumatic agents; arthritis; autoimmune diseases; connective tissue diseases; systemic vasculitis.
Elenco autori:
Andreoli, Laura; Gerardi, Maria Chiara; Gerosa, Maria; Rozza, Davide; Crisafulli, Francesca; Erra, Roberta; Lini, Daniele; Trespidi, Laura; Padovan, Melissa; Ruffilli, Francesca; Serale, Francesca; Cuomo, Giovanna; Raffeiner, Bernd; Semeraro, Paolo; Tani, Chiara; Sole Chimenti, Maria; Conigliaro, Paola; Hoxha, Ariela; Nalli, Cecilia; Fredi, Micaela; Lazzaroni, MARIA GRAZIA; Filippini, Matteo; Taglietti, Marco; Franceschini, Franco; Zatti, Sonia; Loardi, Chiara; Orabona, Rossana; Ramazzotto, Francesca; Zanardini, Cristina; Fontana, Giulia; Gozzoli, Giorgia; Barison, Claudia; Bizioli, Paola; Felice Caporali, Roberto; Carrea, Giulia; Wally Ossola, Manuela; Maranini, Beatrice; Silvagni, Ettore; Govoni, Marcello; Morano, Danila; Verteramo, Rosita; Doria, Andrea; Del Ross, Teresa; Favaro, Maria; Calligaro, Antonia; Tonello, Marta; Larosa, Maddalena; Zen, Margherita; Zambon, Alessandra; Mosca, Marta; Zucchi, Dina; Elefante, Elena; Gori, Sabrina; Iannone, Florenzo; Grazia Anelli, Maria; Lavista, Marlea; Abbruzzese, Anna; Giuseppe Fasano, Carlo; D'Angelo, Salvatore; Stefania Cutro, Maria; Picerno, Valentina; Carbone, Teresa; Anna Padula, Angela; Rovere-Querini, Patrizia; Canti, Valentina; De Lorenzo, Rebecca; Cavallo, Ludovica; Ramoni, Véronique; Montecucco, Carlomaurizio; Codullo, Veronica; Milanesi, Alessandra; Pazzola, Giulia; Comitini, Giuseppina; Marvisi, Chiara; Salvarani, Carlo; Massimiliano Epis, Oscar; Benedetti, Sara; Di Raimondo, Giuseppina; Gagliardi, Clizia; Lomater, Claudia; Crepaldi, Gloria; Bellis, Elisa; Bellisai, Francesca; Garcia Gonzalez, Estrella; Paola Pata, Anna; Zerbinati, Martina; Letizia Urban, Maria; Mattioli, Irene; Iuliano, Annamaria; Sebastiani, Giandomenico; Luca Brucato, Antonio; Bizzi, Emanuele; Cutolo, Maurizio; Santo, Leonardo; Tonetta, Sara; Landolfi, Gianpiero; Carrara, Greta; Bortoluzzi, Alessandra; Alberto Scirè, Carlo; Tincani, Angela; it Investigators of the Italian Society for Rheumatology (SIR), on behalf of the P-RHEUM.
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