Pregnancy in adult‐onset dermatomyositis/polymyositis: A systematic review

Abstract

Background: Idiopathic inflammatory myopathy (IIM) in pregnancy is uncommon but may result in complications for both mother and the fetus. Aim:In this systematic review, we summarized the current literature investigating outcomes of pregnancy related to the dermatomyositis/polymyositis (DM/PM) process. Content:We searched PubMed, Embase, Cochrane Library, and Web of Science databases and included 61 studies reporting the disease course, pregnancy outcomes, and management of both pregnancy and DM/PM in the final analysis.The specific information of 221 pregnancies was extracted and these pregnancies were divided into three distinct forms: pregnancies after disease onset (n = 159), pregnancies with new disease onset (n = 37), and pregnancies followed by postpartum onset (n = 25). In most cases, DM/PM disease activity remained stable or improved throughout pregnancy (80.2%) and the postpartum period (83.9%). Active DM/PM during pregnancy significantly increased the risk of stillbirth or neonatal death (12% vs. 1%, P = .005) and preterm birth (34.7% vs. 11%, P < .001). The rates of other poor outcomes (total fetal loss, low birth weight, and intrauterine growth retardation) were also increased in pregnancies with active disease. Mainstay treatments for active DM/PM during pregnancy are glucocorticoids and intravenous immunoglobins. Implications:The present results underline the importance of good control of myopathy in optimizing the pregnancy outcomes of women with DM/PM.

Clinical Characterization and Ancillary Tests in Susac Syndrome

“…Some autoimmune diseases tend to improve during pregnancy; female patients with dermatomyositis have stable or improving symptoms during pregnancy and postpartum. 17 Future research is needed to evaluate whether that is the case in pregnant patients with SuS. Treatment options and management strategy are discussed in more details in a recently published review of SuS and pregnancy.…”

Pregnancy in pemphigus vulgaris: A systematic review

“…In more complicated circumstances, immunosuppressants such as azathioprine or mycophenolate mofetil are used as adjuvants alongside corticosteroids in nonpregnant state 26 . During pregnancy, the use of methotrexate and mycophenolate mofetil is associated with toxicity while azathioprine is proven to be relatively safe 30 . IVIG and plasma exchange are alternative options 26 .…”

“…26 During pregnancy, the use of methotrexate and mycophenolate mofetil is associated with toxicity while azathioprine is proven to be relatively safe. 30 IVIG and plasma exchange are alternative options. 26 Assessment of disease severity should be emphasized in consideration of treatment strategy.…”

Pregnancy associated anti-TIF1 dermatomyositis responsive to intravenous immunoglobulin

“…Tang et al. 4 sought to summarize the current literature on pregnancy outcomes in DM and polymyositis (PM). Their systematic review identified 61 studies, the majority consisting of case reports and case series.…”