AB0843 OBSTETRIC AND PERINATAL OUTCOMES IN MEXICAN WOMEN WITH RHEUMATIC DISEASES

Abstract

Background:Rheumatic diseases (RD) are more frequent among women of childbearing age. Adverse events during pregnancy in RDs have been frequently reported, leading some women to avoid pregnancy. “CEER” is an outpatient clinic in Monterrey, Nuevo Leon, Mexico, that was created for pregnant women with RD.Objectives:The objective is to describe pregnancy outcomes in patients with RD surveilled at a rheumatology outpatient clinic.Methods:A single-center retrospective study of women with RD at CEER between 2017 and 2020 was conducted. Clinical features and maternal, fetal and neonatal outcomes were retrospectively collected. The rate of adverse perinatal outcomes (APO) was compared with the tertiary referral center´s general obstetric population (GOP). All data was retrieved from clinical files.Results:Overall, 62 pregnancies in women with RD were recorded. The median maternal age at conception was significantly higher in pregnancies with RD than GOP (29 [24-35] years old vs 23 [19-28] years old, p<0.001).The odds of preterm delivery were increased among pregnancies with RD (OR 1.85, 95% CI 1.03-3.30, p=0.038). Other APO are summarized in Table 1. Rheumatoid arthritis (RA) was the leading diagnosis followed by systemic erythematosus lupus (SLE) and antiphospholipid syndrome (APS).Cesarean sections were recorded in 41 pregnancies in RD group, more frequent than in GOP (66.1% vs 50.8%, p=0.016). Figure 1 shows the distribution of indications for cesarean sections, the two leading indications were previous cesarean section (43.9%) and Nonreassuring fetal heart rate pattern (19.5%) Pregnancies with RD appeared to have frequent, emergency cesarean sections and preterm deliveries compared with GOP (12.9% vs 15.9%, p=0.02 and 23.7% vs 12.2%, p=0.006, respectively).Conclusion:Pregnancies with RD were at increased risk for APO. Women of this population should be made aware of these risks and be closely monitored by a multidisciplinary team as a high-risk pregnancy.References:[1]Aljary H, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Pregnancy outcomes in women with rheumatoid arthritis: a retrospective population-based cohort study. J Matern Fetal Neonatal Med. 2020;33(4):618-24.[2]Alvarez-Nemegyei J, Cervantes-Díaz MT, Avila-Zapata F, Marín-Ordóñez J. [Pregnancy outcomes before and after the onset of rheumatoid arthritis]. Rev Med Inst Mex Seguro Soc. 2011;49(6):599-604.[3]Davutoğlu EA, Ozel A, Yilmaz N, Madazli R. Pregnancy outcome in 162 women with rheumatic diseases: experience of a university hospital in Turkey. Arch Gynecol Obstet. 2017;296(6):1079-84.[4]Harris N, Eudy A, Clowse M. Patient-Reported Disease Activity and Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus and Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2019;71(3):390-7.[5]Ideguchi H, Ohno S, Uehara T, Ishigatsubo Y. Pregnancy outcomes in Japanese patients with SLE: retrospective review of 55 pregnancies at a university hospital. Clin Rev Allergy Immunol. 2013;44(1):57-64.Table 1.Pregnant outcome, maternal, fetal and neonatal adverse eventsRD (n=62)GOP (n=31254)OR (CI 95%)pPregnancy outcomePregnancy lossa6 (9.68)1560 (4.99)1.94 (0.84-4.49)0.122Live birthsa60 (90.9)29694 (95)0.96 (0.67-1.35)0.8Gestational age,median (IQR) (weeks)b37.6 (37-39)39 (38-40.2)-<0.001Birth weight,mean (CI) (Kg)c2831.6(2677.4-2985.8)3022.2(2986.8-3057.6)-0.007Maternal adverse eventsPreterm deliveries(<37 weeks)a14 (23.7)3821 (12.2)1.85 (1.03-3.3)0.038<34 weeksa3 (5.1)1065 (3.4)1.42 (0.45-4.53)0.553Gestational diabetesa4 (6.5)1406 (4.5)1.43 (0.52-3.95)0.485Preeclampsiaa5 (8.1)2471 (7.89)1.02 (0.41-2.54)0.97Postpartum hemorrhagea0930 (2.97)0.27 (0.017-4.35)0.355Emergency cesarean sectiona8 (12.9)1844 (5.9)2.19 (1.05-4.57)0.037Fetal adverse eventsMiscarriagesa3 (4.8)663 (2.12)2.28 (0.71-7.29)0.164Stillbirthsa3 (4.8)897 (2.87)1.69 (0.53-5.38)0.377Congenital abnormalitiesa4 (6.5)1094 (3.5)1.84 (0.67-5.08)0.237an,%bIQR, interquartile range (25th–75th percentile)cCI, confidence interval (95%)Disclosure of Interests:None declared