BackgroundIn Mexico, over 60% of the population is uninsured and not able to afford private healthcare services. Women with autoimmune rheumatic diseases (ARDs) are a high-risk group during pregnancy. Morbidity associated with ARDs and pregnancy can include lower birth weight, increased preterm delivery, and more emergency cesarean sections than pregnant women without ARDs. Close monitoring and multidisciplinary care are necessary to prevent and timely treat complications, on the other hand these health interventions are not available to all women with ARDs because of the high prices that it represents.ObjectivesThe aim of this study was to estimate the cost of prenatal care in women with ARDs without health insurance in Northeast Mexico.MethodsTo assess the costs of prenatal care of women with ARDs in the Northeast of Mexico from the perspective of a women without any health insurance, we estimated only the direct costs of the mandatory medical follow-up. Direct costs are all healthcare costs that are directly related to the consultations with a multidisciplinary team, serological and immune laboratory test, and ultrasounds per trimester. All costs and medical fees were obtained from a university hospital in Monterrey, Mexico. To assess the impact of prenatal care in real life, we compared the health expenditure per trimester reported by the pregnancy and rheumatic diseases clinic from the same institution. The data is presented in USD. We were not able to assess indirect costs related to health coverage (like transportation) and specific medical treatment (antirheumatic drugs or other interventions).ResultsThe mean cost for medical consultations and ultrasounds per trimester was $184-277 USD. The average cost of immune test and general lab test ranges from $424-428 USD. The total cost per trimester was from $608 to 705 USD, and the direct cost per three trimesters was $1824-2115 USD.The average family income per month was $614.23 USD and the average health expenditure (per month) was 105.71 USD; which represents 16.21% of the family income. The average family health expenditure per trimester was $317.13 USD.ConclusionThe total cost for prenatal care per trimester was calculated in $608 to 705 USD. The cost of prenatal care per trimester is 193.69% higher than the average health expenditure per trimester for uninsured women with ARDs. More and new strategies are needed to solve and reduce inequalities in access to health.Table 1.Average cost of prenatal care per trimesterMedical consultations and ultrasoundsMedical ConsultationsCosts (USD)FrecuencyCOST PER TRIMESTER $184-277 USDRheumatologist$13MonthlyGenetics$49At least oneObtetrician$14MonthlyUS 1st Trimester$54Only one timeUS 2nd Trimester$49Only one timePsychologist$39If neededNutritionist$5If neededClinical testClinical testCosts (USD)FrecuencyCOST PER TRIMESTER $188 USDComplete Blood Count$9One per trimesterBlood Chemistry$38One per trimesterVitamin D (25-OH)$59One per trimesterThyroid profile test$16One per trimesterPT, TTP$36One per trimesterProtein C reactive$20One per trimesterErythrocyte sedimentation rate$5One per trimesterUrine general test$5One per trimesterImmune lab test (For patients with rheumatoid arthritis and spondylarthritis)Immune lab testCosts (USD)FrecuencyCOST PER TRIMESTER $240 USDRheumatoid factor$24One per trimesterAnti-CCP$33One per trimesterAnti SS-A/RO$19One per trimesterAnti-SS-B/LA$19One per trimesterAnticardiolipins$33One per trimesterBeta-2-glycoprotein$66One per trimesterLupus anticoagulant$46One per trimesterImmune lab test (For patients with lupus, antiphospholipid syndrome, Sjogren’s syndrome, vasculitis, and others) (Others: rheumatic skin and muscle diseases,)Immune lab testCosts (USD)FrecuencyCOST PER TRIMESTER $236 USDAnti-SS-A/RO$21One per trimesterAnti-SS-B/LA$21One per trimesterAnticardiolipins$33One per trimesterBeta-2-glycoprotein$66One per trimesterLupus anticoagulant$46One per trimesterAnti-DNA$24One per trimesterAntinuclear antibodies$25One per trimesterDisclosure of InterestsNone declared

Background:Gender violence is a prevalent issue worldwide. In Mexico, four out of ten women suffer any kind of violence. The factors that make women even more vulnerable to domestic violence are pregnancy, socioeconomic status, educational level, and the presence of chronic health problems. Violence represents a major risk factor for depression, anxiety, poor adherence to medical treatment, and obstetric adverse events.Objectives:The aim of this study is to determine the frequency of domestic violence in pregnant and postpartum women with autoimmune rheumatic diseases (ARD) and to compare with childbearing age women with ARD.Methods:Pregnant and postpartum women (PPW) with rheumatic disease evaluated at the Pregnancy and Rheumatic Diseases Clinic from the University Hospital “Dr. José E. González” in Monterrey, México from August to October 2020 were invited to participate. To compare, we enrolled childbearing age women with ARD without previous pregnancies. The Spanish validated version of the Hurt, Insulted, Threatened with Harm, Screamed scale (HITS) was applied via telephonic interview. The HITS scale evaluates in 4 questions the presence and frequency of violence by their intimate partners in the last 12 months. A score ≥ 10 points is considered as positive for violence.Results:A total of 48 women were included, 24 patients each group. The pregnant-postpartum group was divided in 6 (25) pregnant and 18 (75) postpartum women. Most of them were housewives (54.1%) with >10 years of education and with not formalized marital status 41% (common-law marriage). In the childbearing age group, most of them were employees (70.8), with >10 years of education with a current marital status of single (66.6%). The HITS scale was positive in the pregnant-postpartum group in 4 women (16.6%). Two of them had been victims of sexual assault and 2 reported physical/verbal violence. While in childbearing age group only 1 (4.16) reported physical/verbal violence.Conclusion:The 16% of the pregnant-postpartum group in our sample were suffering from domestic violence by their intimate partners, in contrast to the childbearing age group with only 1 patient reported violence. We found that postpartum and pregnancy women had more prevalence of violence. Screening for domestic violence followed by counseling and early referral are necessary to mitigate the physical and psychological consequences of domestic violence.References:Moreira DN, Pinto da Costa M. The impact of the Covid-19 pandemic in the precipitation of intimate partner violence. Int J Law Psychiatry. 2020;71:101606. doi:10.1016/j.ijlp.2020.101606.Jackson CL, Ciciolla L, Crnic KA, Luecken LJ, Gonzales NA, Coonrod DV. Intimate partner violence before and during pregnancy: related demographic and psychosocial factors and postpartum depressive symptoms among Mexican American women. J Interpers Violence. 2015;30(4):659-679. doi:10.1177/0886260514535262.Table 1.Sociodemographic characteristics and scale resultsPostpartum and pregnancy womenn= 24Childbearing age womenn= 24Age, years, mean27.527.08Occupation, n (%)Housewive13 (54.1)5 (20.8)Employee7 (29.1)17 (70.8)Student4 (16.6)2 (8.3)Education years, n (%)Less than 10 years11 (45.8)7 (29.1)More than 10 years13 (54.1)17 (70.8)Marital status, n (%)Common-law marriage10 (41.6)-Married8 (33.3)8 (33.3)Single6 (24.9)16 (66.6)Status, n (%)Postpartum18 (75)-Pregnancy6 (25)-Results of the HITS scaleTotal, mean5.374.37Score per ranges, n (%)0 – 9 points20 (83.3)23 (95.8)10 – 20 points4 (16.6)1 (4.1)Disclosure of Interests:None declared

Background:Rheumatic diseases (RD) are more frequent among women of childbearing age. Adverse events during pregnancy in RDs have been frequently reported, leading some women to avoid pregnancy. “CEER” is an outpatient clinic in Monterrey, Nuevo Leon, Mexico, that was created for pregnant women with RD.Objectives:The objective is to describe pregnancy outcomes in patients with RD surveilled at a rheumatology outpatient clinic.Methods:A single-center retrospective study of women with RD at CEER between 2017 and 2020 was conducted. Clinical features and maternal, fetal and neonatal outcomes were retrospectively collected. The rate of adverse perinatal outcomes (APO) was compared with the tertiary referral center´s general obstetric population (GOP). All data was retrieved from clinical files.Results:Overall, 62 pregnancies in women with RD were recorded. The median maternal age at conception was significantly higher in pregnancies with RD than GOP (29 [24-35] years old vs 23 [19-28] years old, p<0.001).The odds of preterm delivery were increased among pregnancies with RD (OR 1.85, 95% CI 1.03-3.30, p=0.038). Other APO are summarized in Table 1. Rheumatoid arthritis (RA) was the leading diagnosis followed by systemic erythematosus lupus (SLE) and antiphospholipid syndrome (APS).Cesarean sections were recorded in 41 pregnancies in RD group, more frequent than in GOP (66.1% vs 50.8%, p=0.016). Figure 1 shows the distribution of indications for cesarean sections, the two leading indications were previous cesarean section (43.9%) and Nonreassuring fetal heart rate pattern (19.5%) Pregnancies with RD appeared to have frequent, emergency cesarean sections and preterm deliveries compared with GOP (12.9% vs 15.9%, p=0.02 and 23.7% vs 12.2%, p=0.006, respectively).Conclusion:Pregnancies with RD were at increased risk for APO. Women of this population should be made aware of these risks and be closely monitored by a multidisciplinary team as a high-risk pregnancy.References:[1]Aljary H, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Pregnancy outcomes in women with rheumatoid arthritis: a retrospective population-based cohort study. J Matern Fetal Neonatal Med. 2020;33(4):618-24.[2]Alvarez-Nemegyei J, Cervantes-Díaz MT, Avila-Zapata F, Marín-Ordóñez J. [Pregnancy outcomes before and after the onset of rheumatoid arthritis]. Rev Med Inst Mex Seguro Soc. 2011;49(6):599-604.[3]Davutoğlu EA, Ozel A, Yilmaz N, Madazli R. Pregnancy outcome in 162 women with rheumatic diseases: experience of a university hospital in Turkey. Arch Gynecol Obstet. 2017;296(6):1079-84.[4]Harris N, Eudy A, Clowse M. Patient-Reported Disease Activity and Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus and Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2019;71(3):390-7.[5]Ideguchi H, Ohno S, Uehara T, Ishigatsubo Y. Pregnancy outcomes in Japanese patients with SLE: retrospective review of 55 pregnancies at a university hospital. Clin Rev Allergy Immunol. 2013;44(1):57-64.Table 1.Pregnant outcome, maternal, fetal and neonatal adverse eventsRD (n=62)GOP (n=31254)OR (CI 95%)pPregnancy outcomePregnancy lossa6 (9.68)1560 (4.99)1.94 (0.84-4.49)0.122Live birthsa60 (90.9)29694 (95)0.96 (0.67-1.35)0.8Gestational age,median (IQR) (weeks)b37.6 (37-39)39 (38-40.2)-<0.001Birth weight,mean (CI) (Kg)c2831.6(2677.4-2985.8)3022.2(2986.8-3057.6)-0.007Maternal adverse eventsPreterm deliveries(<37 weeks)a14 (23.7)3821 (12.2)1.85 (1.03-3.3)0.038<34 weeksa3 (5.1)1065 (3.4)1.42 (0.45-4.53)0.553Gestational diabetesa4 (6.5)1406 (4.5)1.43 (0.52-3.95)0.485Preeclampsiaa5 (8.1)2471 (7.89)1.02 (0.41-2.54)0.97Postpartum hemorrhagea0930 (2.97)0.27 (0.017-4.35)0.355Emergency cesarean sectiona8 (12.9)1844 (5.9)2.19 (1.05-4.57)0.037Fetal adverse eventsMiscarriagesa3 (4.8)663 (2.12)2.28 (0.71-7.29)0.164Stillbirthsa3 (4.8)897 (2.87)1.69 (0.53-5.38)0.377Congenital abnormalitiesa4 (6.5)1094 (3.5)1.84 (0.67-5.08)0.237an,%bIQR, interquartile range (25th–75th percentile)cCI, confidence interval (95%)Disclosure of Interests:None declared

Background:The reproductive capacity of women with rheumatic diseases (RD) could be affected by factors such as sexual dysfunction, reduced gonadal function, foetal losses, drugs, and personal choices [1]. Studies have suggested that women with RD may underestimate their reproductive capacity [2], which may be reflected in unplanned pregnancies and/or adverse outcomes. One study found that women with rheumatoid arthritis (RA) have longer time to pregnancy compared to those without RA, suggesting that a reduction in fertility may be involved [3]. Another study found that patients with RA have more subfertility related to medication [4]. Aspects of sexual and reproductive health are not routinely addressed, so they are areas of opportunity to improve quality in care and research.Objectives:Identify demographic and clinical factors associated with pregnancy decision in women with RD.Methods:A population study was carried out including women with RD who had their first obstetric event from September 2017 to November 2020. According to the onset of sexual life and the year of conception of the first pregnancy, two groups were formed, who conceived before and after 5 years elapsed. Demographic and clinical data were obtained from medical records. Categorical variables were assessed using χ2 test and Fisher’s exact test where appropriate. Student’s t-test was used to assess continuous variables. A p value of 0.05 or less was considered significative.Results:Data were collected from 28 women, the main diagnosis was rheumatoid arthritis (21, 75%), followed by systemic lupus erythematosus (7, 25%), 14 of them (50%) were pregnant in the first 5 years after starting sex life. There were no differences in age of onset of sex life (p = 0.362), or other clinical characteristic, but women with pregnancies in the first lustrum had lower percentages of marriage union (35% vs 42%), paid-work (21% vs 28%), and use of highly effective contraception (21% vs 28%).Conclusion:Conclusions: No factors were identified for pregnancies in the first lustrum, but there is a tendency to occur in single women, non-employees, and users of non-highly effective contraceptives methods. Further studies with a larger population are necessary to find modifiable factors and improve outcomes.Table 1.Clinical characteristics.Obstetric event before 5 yearsObstetric event after 5 yearsp-valueTotal1414Current average age24.85 +/- 4.329.92 +/- 5.70.404Age at the first obstetric event, years20.92 +/- 2.928.00 +/- 5.90.05Age at the onset of rheumatic disease, years20.71 +/- 5.523.42 +/- 4.00.135Average age of onset of sex life, n (%)18.64 +/- 2.918.07 +/- 2.50.362Alcoholism consumption, n (%)3 (21.42)4 (28.57)0.663Tobacco use, n (%)3 (21.42)3 (21.42)Diabetes mellitus, n (%)0 (0)1 (7.14)0.309Hypertension, n (%)1 (7.14)0 (0)0.309Depression, n (%)3 (21.42)1 (7.14)0.280Anxiety, n (%)2 (14.28)1 (7.14)0.541Pre-pregnancy medicationMethotrexate, n (%)3 (21.42)5 (35.71)0.403Leflunomide, n (%)1 (7.14)2 (14.28)0.541Sulfasalazine, n (%)3 (21.42)2 (14.28)0.622Hydroxichloroquine, n (%)6 (42.85)4 (28.57)0.430Azathioprine, n (%)1 (7.14)0 (0)0.309Cyclophosphamide, n (%)2 (14.28)0 (0)0.142Glucocorticoids, n (%)5 (35.71)5 (35.71)NA: Not applicable.Image 1.Demographic characteristics.References:[1]Østensen, M., 2017. Sexual and reproductive health in rheumatic disease. Nature Reviews Rheumatology, 13(8), pp.485-493.[2]Birru Talabi, M., Clowse, M., Blalock, S., Switzer, G., Yu, L., Chodoff, A. and Borrero, S., 2019. Development of ReproKnow, a reproductive knowledge assessment for women with rheumatic diseases. BMC Rheumatology, 3(1).[3]Jawaheer, D., Zhu, J., Nohr, E. and Olsen, J., 2011. Time to pregnancy among women with rheumatoid arthritis. Arthritis & Rheumatism, 63(6), pp.1517-1521.[4]Brouwer, J., Fleurbaaij, R., Hazes, J., Dolhain, R. and Laven, J., 2017. Subfertility in Women With Rheumatoid Arthritis and the Outcome of Fertility Assessments. Arthritis Care & Research, 69(8), pp.1142-1149.Disclosure of Interests:None declared

Background:Rheumatic diseases occur among women of childbearing age, adverse events during pregnancy in rheumatic diseases have been frequently reported. Mexico has one of the largest prevalence of cesarean section in women which negatively impacts the product.Objectives:The objective of this study is to describe the frequency of cesarean section in women with autoimmune rheumatic diseases compared to a control group.Methods:We conducted a cross-sectional and retrospective study in patients from the pregnancy and rheumatic diseases clinic, and the Obstetrics department form the University Hospital “Dr. José E. González” in Northeast Mexico. Women with autoimmune rheumatic diseases that gave birth between August 2017 to December 2020 were included. All the data, including the way of birth was retrieved from the clinical files.Results:One hundred and twelve patients were included (56 in the rheumatic disease group and 56 women without rheumatic diseases), two of them suffered miscarriage (one from the rheumatic disease group and 1 from the control group) giving a total of 110 products. The mean age was 29.6 years for the rheumatic patients and 24.6 for the control group. The most frequent rheumatic disease was RA in 22 patients (39.2%), followed by SLE in 13 patients (23.21%).From the 56 pregnancies on the rheumatic disease group more than half ended by cesarean section (n=33, 58.92%) and there were 22 simple vaginal delivery. Table 1. On the control group there were 24 cesarean section procedures and 31 simple vaginal delivery. The indications for cesarean sections are presented in Figure 1. No statistically significant difference was found on cesarean section prevalence between both groups (p=0.389).The most common indication for cesarean section in all patients was previous cesarean procedure. (n=12, 36.36%). There were more pathological fetal cardiotocographic changes (PFCC) as an indication for cesarean section on the rheumatic diseases group (n=11, p 0.002) compared with the control group (n=1).Conclusion:A higher prevalence of cesarean sections was found in women with rheumatic diseases versus women without rheumatic diseases, although this difference was not statistically significant. Studies with a higher sample size are necessary to elucidate the complications and differences between both groups.References:[1]Jara LJ, Cruz-Dominguez MDP, Saavedra MA. Impact of infections in autoimmune rheumatic diseases and pregnancy. Curr Opin Rheumatol. 2019;31(5):546-52.[2]Saavedra MA, Sánchez A, Bustamante R, Miranda-Hernández D, Soliz-Antezana J, Cruz-Domínguez P, et al. [Maternal and fetal outcome in Mexican women with rheumatoid arthritis]. Rev Med Inst Mex Seguro Soc. 2015;53 Suppl 1:S24-9.[3]Smeele HTW, Dolhain R. Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Semin Arthritis Rheum. 2019;49(3s):S32-s5.[4]Sugawara E, Kato M, Fujieda Y, Oku K, Bohgaki T, Yasuda S, et al. Pregnancy outcomes in women with rheumatic diseases: a real-world observational study in Japan. Lupus. 2019;28(12):1407-16.[5]Vinet É, Bernatsky S. Outcomes in Children Born to Women with Rheumatic Diseases. Rheum Dis Clin North Am. 2017;43(2):263-73.Table 1.Demographic charecteristicsDISEASEN (%)AGE, YEARS MEANDURATION OF DISEASE, YEARS MEANCESAREAN SECTIONSIMPLE VAGINAL DELIVERYOTHERSRA22 (39.2%)29.956.7711101 MiscarriageAPS9 (16.98)28.222.7781DM3(5.35%)203.521IA3(5.35%)21.5321SS4 (7.14%)30.254.7531JIA2 (3.57%)361511SLE13 (23.21)31.835.3375TOTAL5629.641509433322RA: Rheumatoid Arthritis, APS: Anti-phospholipid syndrome, DM: Dermatomyositis, IA: Idiopathic arthritis, SS: Sjogren syndrome, JIA: Juvenile idiopathic arthritis, SLE: Systemic Lupus ErythematosusDisclosure of Interests:None declared