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-Reference-Cited by-同舟云学术

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

Published:2024-04 Issue:2 Volume:10 Page:e004091
ISSN:2056-5933
Container-title:RMD Open
language:en
Short-container-title:RMD Open

Author:

Andreoli Laura^ORCID,Gerardi Maria Chiara^ORCID,Gerosa Maria^ORCID,Rozza Davide^ORCID,Crisafulli Francesca^ORCID,Erra Roberta^ORCID,Lini Daniele^ORCID,Trespidi Laura^ORCID,Padovan Melissa^ORCID,Ruffilli Francesca^ORCID,Serale Francesca,Cuomo Giovanna^ORCID,Raffeiner Bernd^ORCID,Semeraro Paolo^ORCID,Tani Chiara^ORCID,Chimenti Maria Sole^ORCID,Conigliaro Paola^ORCID,Hoxha Ariela^ORCID,Nalli Cecilia^ORCID,Fredi Micaela^ORCID,Lazzaroni Maria Grazia^ORCID,Filippini Matteo,Taglietti Marco,Franceschini Franco^ORCID,Zatti Sonia^ORCID,Loardi Chiara^ORCID,Orabona Rossana^ORCID,Ramazzotto Francesca,Zanardini Cristina^ORCID,Fontana Giulia^ORCID,Gozzoli Giorgia^ORCID,Barison Claudia^ORCID,Bizioli Paola^ORCID,Caporali Roberto Felice^ORCID,Carrea Giulia,Ossola Manuela Wally^ORCID,Maranini Beatrice^ORCID,Silvagni Ettore^ORCID,Govoni Marcello^ORCID,Morano Danila^ORCID,Verteramo Rosita^ORCID,Doria Andrea^ORCID,Del Ross Teresa,Favaro Maria,Calligaro Antonia,Tonello Marta^ORCID,Larosa Maddalena^ORCID,Zen Margherita^ORCID,Zambon Alessandra,Mosca Marta^ORCID,Zucchi Dina^ORCID,Elefante Elena^ORCID,Gori Sabrina,Iannone Florenzo^ORCID,Anelli Maria Grazia^ORCID,Lavista Marlea^ORCID,Abbruzzese Anna^ORCID,Fasano Carlo Giuseppe,D'Angelo Salvatore^ORCID,Cutro Maria Stefania^ORCID,Picerno Valentina^ORCID,Carbone Teresa^ORCID,Padula Angela Anna^ORCID,Rovere-Querini Patrizia^ORCID,Canti Valentina^ORCID,De Lorenzo Rebecca^ORCID,Cavallo Ludovica,Ramoni Véronique^ORCID,Montecucco Carlomaurizio^ORCID,Codullo Veronica^ORCID,Milanesi Alessandra^ORCID,Pazzola Giulia,Comitini Giuseppina,Marvisi Chiara^ORCID,Salvarani Carlo^ORCID,Epis Oscar Massimiliano^ORCID,Benedetti Sara,Di Raimondo Giuseppina,Gagliardi Clizia^ORCID,Lomater Claudia^ORCID,Crepaldi Gloria,Bellis Elisa^ORCID,Bellisai Francesca,Garcia Gonzalez Estrella^ORCID,Pata Anna Paola^ORCID,Zerbinati Martina,Urban Maria Letizia^ORCID,Mattioli Irene^ORCID,Iuliano Annamaria,Sebastiani Giandomenico^ORCID,Brucato Antonio Luca^ORCID,Bizzi Emanuele^ORCID,Cutolo Maurizio^ORCID,Santo Leonardo^ORCID,Tonetta Sara^ORCID,Landolfi Gianpiero,Carrara Greta^ORCID,Bortoluzzi Alessandra^ORCID,Scirè Carlo Alberto^ORCID,Tincani Angela^ORCID

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.

Publisher

BMJ

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