Undifferentiated Connective Tissue Disease in Pregnancy: A Topic Yet to be Explored

Abstract

Undifferentiated connective tissue disease (UCTD) is characterized by signs and symptoms suggestive of a connective tissue disease (CTD), but not fulfilling criteria for a specific CTD. Although UCTD is probably the most common rheumatic disease diagnosed in pregnant women, data about disease course during pregnancy and perinatal outcomes are very limited. Compared to other CTDs, UCTD seems to have milder clinical manifestations in pregnancy. Its natural history is related to disease activity at conception. In fact, if the disease is in a state of remission or minimal activity at conception, pregnancy outcomes are generally good. On the contrary, patients who become pregnant in a moment of high disease activity and/or who have multiple antibodies positivity show an increased risk of disease flares, evolution to a definite CTD and obstetric complications, such as fetal growth restriction, preeclampsia and preterm birth. Therefore, a preconception assessment is essential in women with UCTD to evaluate maternal and fetal risks, to initiate interventions to optimize disease activity, and to adjust medications to those that are least harmful to the fetus. The aim of the present study was to review the available literature about pregnancy course, maternal and fetal outcomes and therapeutic approaches of pregnant women with UCTD.

Palmar and plantar erythema: An initial presentation of undifferentiated connective tissue disease

“…Although UCTD is the most common rheumatic disorder diagnosed in pregnant women, 2 data on disease course and maternal-fetal outcomes are limited. One uncontrolled study of 20 pregnant patients with UCTD demonstrated that pregnancy may be a trigger for the development of a defined connective tissue disorder.…”

“…1 It can appear to have a mild clinical course and is marked by the absence of severe organ damage or involvement. 1 , 2 Pregnancy represents a possible trigger for the development of a connective tissue disorder; however, the influence of pregnancy on disease course is not well understood. We present the case of a pregnant woman with UCTD with an unusual cutaneous presentation.…”

The level of serum matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1 in newborns from mothers with undifferentiated connective tissue dysplasia

“…Більшість проведених дотепер досліджень у педіатричній практиці щодо НДСТ присвячені вивченню взаємозв'язків між виразністю клініко-біохімічних ознак НДСТ у дітей та підлітків і перебігом диспластикозалежних станів та хвороб [2, 3,10,12,15,16,20,25,26]. Дослідники акушерських аспектів НДСТ акцентують увагу насамперед на рівні захворюваності серед новонароджених від матерів із проявами НДСТ [8,14,22].…”

The mosaic of autoimmunity – Finally discussing in person. The 13th international congress on autoimmunity 2022 (AUTO13) Athens

“…During pregnancy, patients with autoimmune rheumatic diseases often refuse treatment since they think drug administration would cause any damage to their future babies, Tincani reported. Moreover, there are evidence showing that disease activity in pregnancy could cause an increase in both fetal and maternal complications as demonstrated by Mecacci et al [ 167 ]. While only some drugs such as methotrexate, cyclophosphamide, and mycophenolate have teratogenic activities; their use in pregnancy is limited and most of the therapeutic agents used in autoimmune rheumatic diseases do not cause any malformations but may have few pregnancy complications [ 168 ].…”