Multidisciplinary Unit Improves Pregnancy Outcomes in Women with Rheumatic Diseases and Hereditary Thrombophilias: An Observational Study

Abstract

Rheumatic diseases (RD) and hereditary thrombophilias (HT) can be associated with high-risk pregnancies. This study describes obstetric outcomes after receiving medical care at a multidisciplinary consultation (MC) and compares adverse neonatal outcomes (ANOs) before and after medical care at an MC. This study is a retrospective observational study among pregnant women with RD and HT treated at an MC of a university hospital (southern Spain) from 2012 to 2018. Absolute risk reduction (ARR) and number needed to treat (NNT) were calculated. A total of 198 pregnancies were registered in 143 women (112 with RD, 31 with HT), with 191 (96.5%) pregnancies without ANOs and seven (3.5%) pregnancies with some ANOs (five miscarriages and two foetal deaths). Results previous to the MC showed 60.8% of women had more than one miscarriage, with 4.2% experiencing foetal death. MC reduced the ANO rate by AAR = 60.1% (95%CI: 51.6−68.7%). The NNT to avoid one miscarriage was 1.74 (95%CI: 1.5–2.1) and to avoid one foetal death NNT = 35.75 (95CI%: 15.2–90.9). A total of 84.8% of newborns and 93.2% of women did not experience any complication. As a conclusion, the follow-up of RD or HT pregnant women in the MC drastically reduced the risk of ANOs in this population with a previous high risk.

Optimizing Patient Care: A Systematic Review of Multidisciplinary Approaches for SLE Management

“…In total, 1154 people were enrolled in studies comparing intervention and a control group (5 RCTs and 5 cohort studies); 498 patients (mean age: 36.18, SD ± 6.64 years) were included in intervention arms and 656 patients (mean age: 38.40 SD ± 6.77 years) in comparator arms. Two studies did not report the mean age of participants [ 13 , 16 ]. Median disease duration in intervention and comparator groups amounted to 9.5 years (IQR: 7.23–11.35) and 9 years (IQR: 7–10.25), respectively.…”

“…The frequency of adverse neonatal outcomes in standard care was 42.8% in SLE and 90% in APS. However, after the introduction of the MD team, the risk of adverse neonatal outcomes reduced to 36.7% (95% CI: 21.3–52.1) in the SLE group and 87.5% (95% CI: 77–98) in the APS group [ 13 ]. Similar results were observed by Wind et al, who found that maternal outcomes in SLE and primary/secondary APS patients were 36/71 in the historically treated cohort versus 22/41 in the MD-treated one (OR 0.91, 95% CI 0.38–2.17).…”

“…Although it is well known that many organs and systems can be affected in SLE, we observed an imbalance in data focused on SLE pregnancy and (to a lesser extent) psychological aspects; surprisingly, none of the described MD teams analyzed included, for instance, a cardiologist, pulmonologist, or dermatologist, and a nephrologist and hematologist were cited only twice each [ 13 , 19 , 24 ]. Moreover, in only 22% of reviewed studies did the MD teams include more than 1 medical professional (other than a rheumatologist) at the same time.…”

Exploring patient’s experience and unmet needs on pregnancy and family planning in rare and complex connective tissue diseases: a narrative medicine approach

“…Referral to excellence clinics means increased monitoring and being well taken care of before, during and after pregnancy, especially when a multidisciplinary approach is organised, as it is well known that working across medical fields ensures best care for patients. 23 …”

“…Referral to excellence clinics means increased monitoring and being well taken care of before, during and after pregnancy, especially when a multidisciplinary approach is organised, as it is well known that working across medical fields ensures best care for patients. 23 In addition, it is evident that the organisation of training and educational activities both for HCPs as well as for patients and families is crucial in providing a tangible contribution to improve the experience of patients and also to better support the patient-clinician relationship.…”