Maternal and foetal outcome of pregnancy in women with connective tissue diseases
Keywords:systemic connective tissue diseases, perinatal outcomes, pregnancy complications
Introduction. The majority of patients diagnosed with systemic connective tissue diseases are women of childbearing age.
Aim. The analysis of obstetric results and exacerbation rates in the pregnancies involving systemic connective tissue diseases.
Material and Methods. We retrospectively reviewed perinatal outcomes of fourteen women with systemic connective tissue diseases hospitalised in the Department of Reproduction in the period between September 2019 and July 2021.
Results. Median duration of a pregnancy was 37 weeks. One pregnancy ended in a stillbirth in week 28. Of the 13 live births, preterm delivery occurred in 5 cases. Of the 13 live-birth neonates, preterm delivery occurred in five cases. The Caesarean section rate was 57.1% and vaginal delivery rate was 42.9%. The mean birth weight of the live neonates was 2787g (SD 892), and the median Apgar score in the 1st and the 3rd minute was 10.
In total, all 4 patients with the active disease at the time of conception and 1 who did not decide to undergo the recommended mitral valve surgery prior to pregnancy experienced symptoms indicating a disease flare-up in the course of pregnancy. None of the patients who planned their pregnancy experienced an exacerbation of the disease.
Conclusions. All patients diagnosed with systemic connective tissue diseases should receive multidisciplinary care prior to conception, during pregnancy and in the postpartum period. Furthermore, they should be monitored by a team of specialists, due to the risk of a disease exacerbation and high rates of maternal and foetal complications resulting from the underlying condition.
Gaubitz M. Epidemiology of connective tissue disorders. Rheumatology (Oxford). 2006 Oct;45 Suppl 3:iii3-4. doi: 10.1093/rheumatology/kel282. Erratum in: Rheumatology (Oxford). 2008 Feb;47(2):234-5. PMID: 16987829.
Chakravarty, E. F., Nelson, L. & Krishnan, E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum. 54, 899–907 (2006).
Buyon, J. P. et al. Predictors of pregnancy outcomes in patients with lupus: a cohort study. Ann. Intern. Med.163, 153–163 (2015).
Arkema, E. V. et al. What to expect when expecting with systemic lupus erythematosus (SLE): a population-based study of maternal and fetal outcomes in SLE and pre-SLE. Arthritis Care Res. 68, 988–994 (2016).
Zuppa, A. A. et al. Neonatal lupus: follow-up in infants with anti-SSA/Ro antibodies and review of the literature. Autoimmun. Rev. 16, 427–432 (2017)
Clark CA, Spitzer KA, Laskin CA. Decrease in pregnancy loss rates in patients with systemic lupus erythematosus over a 40-year period. J Rheumatol [Internet]. 2005 Sep. [cited 2017 Dec 18];32(9):1709–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16142865
Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum. 2006;54:899–907. doi: 10.1002/art.21663
Dina Zucchi , Chiara Tani , Francesca Monacci et al. Pregnancy and undifferentiated connective tissue disease: outcome and risk of flare in 100 pregnancies. Rheumatology (Oxford). 2020 Jun 1;59(6):1335-1339. doi: 10.1093/rheumatology/kez440.
Massimo Radin et.al. Pregnancy outcomes in mixed connective tissue disease: a multicentre study. Rheumatology 2019 Nov 1;58(11):2000-2008. doi: 10.1093/rheumatology/kez141.
Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Annals of the Rheumatic Diseases 2017;76:476-485.
Bouvier S, Cochery-Nouvellon E, Lavigne-Lissalde G, et al. Comparative incidence of pregnancy outcomes in treated obstetric antiphospholipid syndrome: the NOH-APS observational study. Blood 2014;123:404–13. doi:10.1182/blood-2013-08-522623
Jeremic K, Stefanovic A, Dotlic J, et al. Neonatal outcome in pregnant patients with antiphospholipid syndrome. J Perinat Med 2015;43:761–8. doi:10.1515/jpm-2014-0118
Cervera R, Piette JC, Font J, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002;46:1019-27. doi:10.1002/art.10187
Alijotas-Reig J, Ferrer-Oliveras R, Ruffatti A, et al The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): a survey of 247 consecutive cases. Autoimmun Rev 2015;14:387–95. doi:10.1016/j.autrev.2014.12.010
Mak A. et al. Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression. Rheumatology 2010; 49,281-288
Chrzanowska A, Irzyk K, Dudzik-Niewiadomska I. et al Circulatory system in patients with systemic lupus erythematosus Folia Cardiologica 2016 ; 11 ( 2), 111–118
Petri M., Lakatta C., Magder L.,Goldman D. Effect of prednisone and hydroxychloroquine on coronary artery disease risk factors in systemic lupus erythematosus: a longitudinal data analysis. Am. J. Med. 1994; 96: 254–259.
Perez-Villa F., Font J., Azqueta M. et al. Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: a prospective, long-term, followup study. Arthritis Rheum. 2005; 53: 460–467.
How to Cite
Copyright (c) 2021 The copyright to the submitted manuscript is held by the Author, who grants the Journal of Medical Science (JMS) a nonexclusive licence to use, reproduce, and distribute the work, including for commercial purposes.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.