Outcomes of Pregnancy in Women With Inflammatory Myositis

Abstract

Objectives Idiopathic inflammatory myositis (IIM) commonly affects women in the childbearing age group. Both disease activity and immunosuppressants used may have adverse effects on fertility and outcomes of pregnancy. We explored these outcomes in a cohort of women with IIM. Methods Women 18 years or older with IIM (Bohan and Peter criteria) were interviewed for demography, menstrual status, history of conception, outcomes, and disease features. Comparisons were drawn between pregnancies occurring before and after onset of disease. Results Eighty-one IIM patients with median age of 32 years (interquartile range, 26–50 years) and disease duration of 4 years (interquartile range, 2–9 years) were interviewed. Forty-five patients had dermatomyositis, 20 had polymyositis, and 16 had overlap myositis. Sixty-three patients had conceived before disease onset, resulting in 205 pregnancies and 155 live births over 315.2 patient-years of follow-up. After disease onset, there were 24 pregnancies (6 live births, 16 spontaneous abortions, and 2 induced abortions) in 7 women over 77.5 patient-years. Of the live births, 1 had cleft palate, 1 had low birth weight, and 1 was preterm. None of the patients who conceived had antiphospholipid antibodies. Obstetric complications (relative risk [RR] = 7.6; p < 0.0001) and fetal complications (RR = 2.7; p = 0.002) occurred more frequently in pregnancies after the onset of myositis, although there was no difference in maternal complications. Conception after the onset of myositis had higher risk of abortion (RR = 3.6; p < 0.0001). Conclusions Women with IIM suffer from poor fetal outcomes as well as high rates of spontaneous abortion rates in the absence of clinical or serologic anti-phospholipid syndrome.

Poor obstetric outcomes in Indian women with Takayasu arteritis

“…Poor obstetric care in a developing nation could be another reason. It has been previously shown from our hospital that women with inflammatory myositis, suffer from much poorer maternal outcomes than reported from other countries [10]. However, since the type of TA and consequently patterns of vascular involvement also differ geographically, it might be difficult to allocate attributability to poor outcomes from disease phenotype viz.…”

“…Peripartum onset of disease is seen in many autoimmune diseases [10,24]. In TA which tends to be latent in a subset of individuals, the altered hemodynamics of pregnancy can lead to decompensation and consequent diagnosis.…”

“…The scenario in India may be different [10]. In TA, it is well established that the pattern of vascular involvement differs by region with a plausible role of dynamic interactions of the genes with the environment.…”

Neuromuscular disorders in pregnancy

“…In contrast, active disease is associated with increased fetal mortality, low birth weight, and prematurity ( Silva et al, 2003 ; Váncsa et al, 2007 ; Nagy-Vincze et al, 2014 ; Zhong et al, 2017 ; Che et al, 2020 ). A large and recent retrospective series from India reviewed 24 pregnancies resulting in only 6 live births, though some were voluntarily terminated ( Gupta et al, 2019 ). Mothers also have longer hospital stays, more hypertensive complications, and higher C-section rates but no other labor or delivery complications ( Kolstad et al, 2018 ).…”

Clinical and Serological Features and Pregnancy Outcomes in Women with Polymyositis/Dermatomyositis: A Case-based Review

“…* described as gestational age at PM/DM onset ¥ due to medical termination • described as CK-MM || severe respiratory failure requiring invasive mechanical ventilation due to respiratory muscle weakness CADM: clinically amyopathic dermatomyositis, ANA: antinuclear antibody, anti-TIF1-γ antibody: anti-transcriptional intermediary factor 1-γ, anti-SRP antibody: anti-signal recognition particle antibody, AZA: azathioprine, CK: creatinine kinase, CS: corticosteroids, C/S: cesarean section, CyA: cyclosporine A, d: day(s), diff spe: diffuse speckled pattern, DEX: dexamethasone, DM: dermatomyositis, HCQ: hydroxychloroquine, IIM: idiopathic inflammatory myositis, IVIG: Intravenous Immunoglobulin, LB: live birth, mPSL: methylprednisolone, MSA: myositis specific antibody, MTX: methotrexate, m: month(s), NA: not assessed, Nu: nucleolar pattern, PB: preterm birth, PH: pregnancy hypertension, PM: polymyositis, PROM: premature rupture of membranes, PSL: prednisolone, PSN: prednisone, SGA: small for gestational age, sp: speckled pattern, y: years, w: week(s) cies complicated with IIM than in those not complicated with IIM(21,23). Zhong et al showed that women with IIM that developed before pregnancy were at a significantly higher risk of either PB or spontaneous abortion than those with IIM that developed during or after pregnancy period (adjusted odds ratio 9.36; p=0.041) (21).…”