Pregnancy outcomes in adult patients with dermatomyositis and polymyositis

Abstract

Objective The idiopathic inflammatory myopathies dermatomyositis (DM) and polymyositis (PM) are autoimmune diseases that can affect females of childbearing potential. We assessed pregnancy outcomes in DM and PM patients compared with the general obstetric population. Methods The Nationwide Inpatient Sample (NIS) (1993–2007) was used to identify delivery-associated hospitalizations in women with DM or PM (DM/PM, n = 853). Controls were from the general obstetric population delivery-associated hospitalizations matched to each case by year of delivery. Pregnancy outcomes included hospital length of stay (LOS), hypertensive disorders (HTN), premature rupture of membranes (PROM), intrauterine growth restriction (IUGR), and cesarean delivery. Multivariate regression analyses were performed using maternal age, race/ethnicity, and diabetes mellitus as covariates. Results On multivariate analysis, patients with DM/PM had longer LOS compared to controls (p < 0.001). DM/PM was associated with an increased risk of hypertensive disorders compared to controls (OR = 2.90, 95% CI: 2.00–4.22). There were no differences in rates of PROM, IUGR, or cesarean section in patients with DM/PM compared with controls. Independent of a DM/PM diagnosis, African-American race, older age, and diagnosis of diabetes increased the hospital LOS (p < 0.001). African-American race and diabetes increased the risk of hypertensive disorders (OR = 1.38, 95% CI: 1.19–1.60; OR = 2.94, 95% CI: 2.04–4.23, respectively) compared to controls. Conclusion These data suggest that patients with inflammatory myopathies are at increased risk of hypertensive disorders of pregnancy and longer length of hospitalization. Vigilant monitoring of blood pressure is advisable in pregnant patients with DM or PM.

Preterm birth phenotypes in women with autoimmune rheumatic diseases: a population‐based cohort study

“…An Italian multicentre study found no increased risk of PPROM but an increased risk of early and late PTB (OR 2.17 versus 2.42) in women with SSc. 33 We observed increased risks of PTB overall and many PTB phenotypes, particularly at early gestational ages, for women with SLE, SSc, and DM/PM. With the differences in populations, it is difficult to make direct comparisons.…”

“…15 For DM/PM, a recent NIS study did not find an increased risk of PPROM; however, other PTB phenotypes were not assessed. 33 We observed increased risks of PTB overall and many PTB phenotypes, particularly at early gestational ages, for women with SLE, SSc, and DM/PM. The observation of a higher risk of delivery at early gestational ages for some diseases may be secondary to bias originating from the depletion of susceptible individuals.…”

“…These studies suggest an increased risk for PTB in SLE but less definitive findings or no evidence for PPROM in women with RA, SSc, and DM/ PM. 7,8,32,33 Furthermore, those analyses did not account for parity, which is an important factor when evaluating adverse pregnancy outcomes such as pre-eclampsia. 34 This study accounted for parity and autocorrelation.…”

The failure of non‐invasive prenatal testing due to maternal dermatomyositis

“…If poor placentation is more common in women with inflammatory myopathies, a higher prevalence of IUGR, prematurity, and fetal loss may also be expected. Kathleen et al only evaluated IUGR, and DM patients trended toward an increased risk of IUGR in univariate analysis, although this was not significant when correcting for potential confounding factors . Prior studies have suggested that patients with myositis are at greater risk of fetal loss and prematurity .…”

Neuromuscular disorders in pregnancy

“…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 ). Neither condition is transmitted to the newborn but interestingly, two asymptomatic newborns were noted to have elevated creatine kinase levels for a few months ( Messina et al, 2002 ).…”