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.
Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospective Italian P-RHEUM.it study / Andreoli, L.; Gerardi, M. C.; Gerosa, M.; Rozza, D.; Crisafulli, F.; Erra, R.; Lini, D.; Trespidi, L.; Padovan, M.; Ruffilli, F.; Serale, F.; Cuomo, G.; Raffeiner, B.; Semeraro, P.; Tani, C.; Chimenti, M. S.; Conigliaro, P.; Hoxha, A.; Nalli, C.; Fredi, M.; Lazzaroni, M. G.; Filippini, M.; Taglietti, M.; Franceschini, F.; Zatti, S.; Loardi, C.; Orabona, R.; Ramazzotto, F.; Zanardini, C.; Fontana, G.; Gozzoli, G.; Barison, C.; Bizioli, P.; Caporali, R. F.; Carrea, G.; Ossola, M. W.; Maranini, B.; Silvagni, E.; Govoni, M.; Morano, D.; Verteramo, R.; Doria, A.; Ross, T. D.; Favaro, M.; Calligaro, A.; Tonello, M.; Larosa, M.; Zen, M.; Zambon, A.; Mosca, M.; Zucchi, D.; Elefante, E.; Gori, S.; Iannone, F.; Anelli, M. G.; Lavista, M.; Abbruzzese, A.; Fasano, C. G.; D'Angelo, S.; Cutro, M. S.; Picerno, V.; Carbone, T.; Padula, A. A.; Rovere-Querini, P.; Canti, V.; De Lorenzo, R.; Cavallo, L.; Ramoni, V.; Montecucco, C.; Codullo, V.; Milanesi, A.; Pazzola, G.; Comitini, G.; Marvisi, C.; Salvarani, C.; Epis, O. M.; Benedetti, S.; Raimondo, G. D.; Gagliardi, C.; Lomater, C.; Crepaldi, G.; Bellis, E.; Bellisai, F.; Gonzalez, E. G.; Pata, A. P.; Zerbinati, M.; Urban, M. L.; Mattioli, I.; Iuliano, A.; Sebastiani, G.; Brucato, A. L.; Bizzi, E.; Cutolo, M.; Santo, L.; Tonetta, S.; Landolfi, G.; Carrara, G.; Bortoluzzi, A.; Scirè, C. A.; Tincani, A.. - In: RMD OPEN. - ISSN 2056-5933. - 10:2(2024). [10.1136/rmdopen-2024-004091]
Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospective Italian P-RHEUM.it study
Filippini M.;Zambon A.;Rovere-Querini P.;De Lorenzo R.;Gagliardi C.;Bizzi E.;
2024-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
