RMD Open (Jul 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,
- 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
Affiliations
- Carlo Alberto Scirè
- 6 Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Alessandra Bortoluzzi
- 6 Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Andrea Doria
- 18 Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
- Micaela Fredi
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Marcello Govoni
- 8 Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Chiara Tani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Angela Tincani
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Maurizio Cutolo
- 39 Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
- Marta Mosca
- University of Pisa, Pisa, Italy
- Elena Elefante
- Department of Clinical and Experimental Medicine, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Margherita Zen
- 18 Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
- Maddalena Larosa
- 18 Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
- Paola Conigliaro
- 13 Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
- Maria Sole Chimenti
- 13 Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
- Veronica Codullo
- 26 Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Cecilia Nalli
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Veronique Ramoni
- 25 Internal Medicine Department, ASST Lodi - Ospedale Maggiore di Lodi, Lodi, Italy
- Carlomaurizio Montecucco
- 26 Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Marco Taglietti
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Valentina Picerno
- 22 Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
- Greta Carrara
- 6 Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Laura Andreoli
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Chiara Marvisi
- 28 Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Carlo Salvarani
- 28 Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Serena Guiducci
- Antonio Luca Brucato
- 37 Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy
- Franco Franceschini
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Giandomenico Sebastiani
- 36 Rheumatology Unit, San Camillo-Forlanini Hospital, Rome, Italy
- Marta Tonello
- 18 Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
- Silvia Bellando-Randone
- Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Giovanna Cuomo
- 10 Precision Medicine Department, University of Campania L. Vanvitelli, Naples, Italy
- Maria Letizia Urban
- 35 Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Maria Gerosa
- 4 Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Ettore Silvagni
- 10 Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S Anna, Ferrara, Italy
- Elisa Bellis
- 33 Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Francesca Bellisai
- 34 Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- Alessandra Milanesi
- 26 Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Patrizia Rovere-Querini
- 24 Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
- Ariela Hoxha
- 14 General Medicine and Thrombosis and Hemorrhagic Unit, Department of Medicine, University of Padua, Padua, Italy
- Salvatore D'Angelo
- 22 Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
- Sonia Zatti
- 15 Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
- Emanuele Bizzi
- 37 Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy
- Gianpiero Landolfi
- 6 Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Bernd Raffeiner
- 11 Department of Rheumatology, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
- Leonardo Santo
- 40 Rheumatology Unit, Mons. Dimiccoli Hospital, Barletta (BT), Italy
- Teresa Del Ross
- 18 Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
- Maria Stefania Cutro
- 22 Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
- Giulia Pazzola
- 28 Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Oscar Massimiliano Epis
- 3 Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Sara Benedetti
- 32 Obstetrics and Gynecology, Maternal Infant Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Maria Favaro
- 18 Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
- Antonia Calligaro
- 18 Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
- Annamaria Iuliano
- 36 Rheumatology Unit, San Camillo-Forlanini Hospital, Rome, Italy
- Sabrina Gori
- 12 Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Francesca Crisafulli
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Matteo Filippini
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Maria Chiara Gerardi
- 3 Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Maria Grazia Lazzaroni
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Cecilia Beatrice Chighizola
- Laura Trespidi
- 7 Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Milan, Italy
- Maria Chiara Ditto
- Cristina Zanardini
- 15 Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
- Roberta Erra
- 7 Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Milan, Italy
- Melissa Padovan
- 8 Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
- Davide Rozza
- 6 Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Claudia Lomater
- 33 Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Daniele Lini
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Valentina Canti
- 24 Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
- Rebecca De Lorenzo
- Vita-Salute San Raffaele University, Milano, Italy
- Francesca Ruffilli
- 8 Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Giulia Carrea
- 4 Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Ludovica Cavallo
- 24 Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
- Alessandra Zambon
- 20 Unit of Obstetrics and Gynecology, Department of Woman and Child Health, University of Padova, Padova, Italy
- Claudia Barison
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Francesca Serale
- 9 Rheumatology Unit, ASL CN1, Cuneo, Italy
- Paolo Semeraro
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Chiara Loardi
- 15 Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
- Rossana Orabona
- 15 Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
- Francesca Ramazzotto
- 15 Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
- Giulia Fontana
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Giorgia Gozzoli
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Paola Bizioli
- 1 Rheumatology and Clinical Immunology Unit – ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Roberto Felice Caporali
- 4 Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Manuela Wally Ossola
- 7 Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Milan, Italy
- Beatrice Maranini
- 8 Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Danila Morano
- 16 Dipartimento Materno Infantile, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Ferrara, Italy
- Rosita Verteramo
- 17 Dipartimento Cure Primarie, UO Servizi Sanitari 1- AUSL Ferrara, Ferrara, Italy
- Maria Grazia Anelli
- 21 Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
- Marlea Lavista
- 21 Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
- Anna Abbruzzese
- 21 Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
- Carlo Giuseppe Fasano
- 21 Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
- Teresa Carbone
- 23 Immunopathology Laboratory, San Carlo Hospital, Potenza, Italy
- Angela Anna Padula
- 22 Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
- Giuseppina Comitini
- 29 Department of Obstetrics and Gynecology, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Giuseppina Di Raimondo
- 32 Obstetrics and Gynecology, Maternal Infant Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Clizia Gagliardi
- 3 Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Gloria Crepaldi
- 33 Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Estrella Garcia Gonzalez
- 34 Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- Anna Paola Pata
- 34 Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- Martina Zerbinati
- 14 General Medicine and Thrombosis and Hemorrhagic Unit, Department of Medicine, University of Padua, Padua, Italy
- Sara Tonetta
- 41 Unit of Rheumatology, Santa Chiara Regional Hospital, APSS, Trento, Italy
- DOI
- https://doi.org/10.1136/rmdopen-2024-004091
- Journal volume & issue
-
Vol. 10,
no. 2
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.
