Pregnancy Outcomes in Women With Rare Autoimmune Diseases

Abstract

Objective. To examine pregnancy outcomes and pregnancy-related health service utilization among women with rare autoimmune diseases.Methods. This population-based cohort study of an Australian obstetric population (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) used birth records linked to hospital records for identification of rare autoimmune diseases including systemic vasculitis, vasculitis limited to the skin, Sj€ ogren's syndrome, systemic sclerosis, Behçet's disease, polymyositis/dermatomyositis, and other systemic involvement of connective tissue. We excluded births in women with systemic lupus erythematosus or rheumatoid arthritis as well as births occurring ‡6 months before the diagnosis of the rare autoimmune disease. Modified Poisson regression was used to compare study outcomes between women with autoimmune diseases and the general obstetric population.Results. There were 991,701 births, including 409 births (0.04%) in 293 women with rare autoimmune diseases. Of the 409 births, 202 (49%) were delivered by cesarean section and 72 (18%) were preterm; these rates were significantly higher than those in the general obstetric population (28% and 7%, respectively). Compared to the general population, women with autoimmune diseases had higher rates of hypertensive disorders, antepartum hemorrhage, and severe maternal morbidity and required longer hospitalization at delivery, more hospital admissions, and tertiary obstetric care. Compared to other infants, those whose mothers had a rare autoimmune disease were at increased risk of admission to a neonatal intensive care unit, severe neonatal morbidity, and perinatal death.Conclusion. While the majority of women with rare autoimmune diseases delivered healthy infants, they were at increased risk of having both maternal complications and adverse neonatal outcomes, suggesting that their pregnancies should be closely monitored.

Pregnancy outcomes in adult patients with dermatomyositis and polymyositis

“…We found that DM/PM patients are hospitalized longer during delivery and are at increased risk of hypertensive disorders, including preeclampsia and eclampsia, a finding that is consistent with prior smaller studies [9,13]. This result persisted after we excluded a diagnosis of pre-existing hypertension.…”

“…In addition, the majority of studies evaluating obstetric outcomes in women with inflammatory myopathies have focused on fetal outcomes with some conflicting results. Multiple case reports and small retrospective studies suggest that fetal outcomes are worse in active disease, with increased risk of spontaneous abortion and prematurity [9–13]. …”

“…One retrospective cohort study of 51 patients found there was no difference in maternal or fetal complications comparing pregnancies before and after disease onset; however, this study was limited by size and the comparison was not made with the general population [18]. Another recent population-based study showed an increase in hypertensive disorders of pregnancy, antepartum hemorrhage, and cesarean deliveries in patients with inflammatory myopathies, however this study only included 17 DM/PM pregnancies [13]. Our goal was to overcome these limitations by using a large publicly available US database to estimate adverse pregnancy outcomes in women with DM/PM compared with the general obstetric population.…”

“…Small studies and case reports suggest that flares of disease activity during pregnancy may result in poor fetal outcomes such as intrauterine growth restriction (IUGR), prematurity, or fetal loss [4,9–12]. There are limited studies evaluating pregnancy outcomes in patients with DM/PM at the population level [13]. The goal of this study was to utilize a US-based nationwide dataset to assess whether women with DM/PM are at greater risk of pregnancy complications compared to women in the general obstetric population.…”

Special considerations in pregnant systemic sclerosis patients

“…In an Australian population-based cohort study, the frequency of preterm births was also significantly higher than in the general obstetric population (30% vs. 7%; unadjusted RR 4.80 [3.03-7.61]) [12]. When adjusted for maternal age, country of birth, socioeconomic status, maternal residence, chronic hypertension, pregestational diabetes, smoking during pregnancy, parity, and multiple births, the RR remained significantly high (4.19 [2.56-6.86]).…”