RMD Open (May 2024)

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

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

DOI
https://doi.org/10.1136/rmdopen-2024-004091
Journal volume & issue
Vol. 10, no. 2

Abstract

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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.