Comparing pregnancy outcomes in patients with criteria and non-criteria autoimmune disease: A systematic review

Abstract

Background Not all patients fulfil criteria for specific autoimmune rheumatic diseases (ARDs) and are then defined as having non-criteria (nc)ARD. It is uncertain whether well-recognised associations with adverse pregnancy outcomes in patients with criteria ARD also exist in patients with ncARD or undifferentiated connective tissue disease (UCTD). Therefore, we undertook a systematic review of the prevalence of adverse pregnancy outcomes in various ncARD and UCTD compared with criteria ARD to identify whether there are increased risks and to examine for any benefits of treatment. Methods This study was conducted in accordance with the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. A systematic literature review was performed using online databases including Medline and PubMed from inception to the beginning of April 2021 using appropriate keywords for various ARD and pregnancy outcomes. Results After screening 665 articles, 36 articles were chosen for full text review and 15 selected for final analysis. There were eight studies of nc antiphospholipid syndrome (APS) of more than 7000 pregnancies and seven studies of UCTD of more than 1000 pregnancies. No studies of any other ncARD in pregnancy were identified. We found that patients with either ncAPS or UCTD seem to have an increased burden of poor pregnancy outcomes compared with the general population. Despite the heterogeneity and poor quality of the studies, we also noted that ncAPS and criteria APS patients may have similar rates of obstetric complications with standard and/or non-standard APS treatment regimens. Conclusion Our findings of increased risks of poor pregnancy outcomes in patients with ncAPS or UCTD will be helpful for pre-pregnancy counselling and management of these patients in pregnancy and support their referral to specialist obstetric-rheumatology and obstetric-haematology clinics.

Clinical phenotype, treatment strategy and pregnancy outcome of non‐criteria obstetric antiphospholipid syndrome

“…NC‐OPAS can increase the risk of adverse pregnancy outcomes, and a systematic review found that patients in NC‐OAPS and OAPS had a similar risk of developing pregnancy complications 37 . The administration characteristics and pregnancy outcomes are described in detail in Tables 5 and 6.…”

“…NC-OPAS can increase the risk of adverse pregnancy outcomes, and a systematic review found that patients in NC-OAPS and OAPS had a similar risk of developing pregnancy complications. 37 The administration characteristics and pregnancy outcomes are described in detail in Tables 5 and 6. Patients with standard anticoagulation therapy can have pregnancy outcomes, and the live birth rate was higher in the NC-OAPS than in the OAPS group (74.17% vs. 68.09%, p = .002), which are close to data from other centers 13 We found a significantly higher live birth rate in the NC-OAPS group, a similar outcome was found in the UROAPS registry, with 85% in the OAPS group and 89.6% in the NC-OAPS group.…”