Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospectiveItalian P-RHEUM.it study
Authors: Andreoli Laura , Gerardi Maria Chiara , Gerosa Maria , Rozza Davide , Crisafulli Francesca , Erra Roberta , Lini Daniele , Trespidi Laura , Padovan Melissa , Ruffilli Francesca , Serale Francesca , Cuomo Giovanna , Raffeiner Bernd , Semeraro Paolo , Tani Chiara , Chimenti Maria Sole , Conigliaro Paola , Hoxha Ariela , Nalli Cecilia , Fredi Micaela , Lazzaroni Maria Grazia , Filippini Matteo , Taglietti Marco , Franceschini Franco , Zatti Sonia , Loardi Chiara , Orabona Rossana , Ramazzotto Francesca , Zanardini Cristina , Fontana Giulia , Gozzoli Giorgia , Barison Claudia , Bizioli Paola , Caporali Roberto Felice , Carrea Giulia , Ossola Manuela Wally , Maranini Beatrice , Silvagni Ettore , Govoni Marcello , Morano Danila , Verteramo Rosita , Doria Andrea , Del Ross Teresa , Favaro Maria , Calligaro Antonia , Tonello Marta , Larosa Maddalena , Zen Margherita , Zambon Alessandra , Mosca Marta , Zucchi Dina , Elefante Elena , Gori Sabrina , Iannone Florenzo , Anelli Maria Grazia , Lavista Marlea , Abbruzzese Anna , Fasano Carlo Giuseppe , D'Angelo Salvatore , Cutro Maria Stefania , Picerno Valentina , Carbone Teresa , Padula Angela Anna , Rovere-Querini Patrizia , Canti Valentina , De Lorenzo Rebecca , Cavallo Ludovica , Ramoni Véronique , Montecucco Carlomaurizio , Codullo Veronica , Milanesi Alessandra , Pazzola Giulia , Comitini Giuseppina , Marvisi Chiara , Salvarani Carlo , Epis Oscar Massimiliano , Benedetti Sara , Di Raimondo Giuseppina , Gagliardi Clizia , Lomater Claudia , Crepaldi Gloria , Bellis Elisa , Bellisai Francesca , Garcia Gonzalez Estrella , Pata Anna Paola , Zerbinati Martina , Urban Maria Letizia , Mattioli Irene , Iuliano Annamaria , Sebastiani Giandomenico , Brucato Antonio Luca , Bizzi Emanuele , Cutolo Maurizio , Santo Leonardo , Tonetta Sara , Landolfi Gianpiero , Carrara Greta , Bortoluzzi Alessandra , Scirè Carlo Alberto , Tincani Angela 
Published: June 2024

Objectives
To investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it.

Methods
Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018–2023). Maternal and infant information were collected in a web-based database.

Results
We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress.

Conclusions
Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures.