FRI0515 MATERNAL AND PERINATAL OUTCOMES IN WOMEN WITH RHEUMATIC DISEASES – A 10-YEAR EXPERIENCE FROM A PORTUGUESE TERTIARY CENTRE
Authors: A. R. Cruz-Machado, S. C. Barreira, P. Martins, M. Centeno, C. Araújo, L. Pinto, S. Capela
Journal: Annals of the Rheumatic Diseases (2020)

Background: Pregnant women with rheumatic diseases (RD) represent a population at a higher risk for adverse pregnancy outcomes (APO). At our unit, these patients (pts) are surveilled at a high-risk pregnancy clinic, by both rheumatologists and obstetricians. Objectives: To assess pregnancy outcomes in pts with RD surveilled at our unit over the last decade. Methods: Single-centre observational retrospective study of pregnant women with RD followed at a portuguese tertiary centre between 2009 to 2019. Results: Overall, 353 pregnancies (preg) in 295 pts with RD were managed at our unit. Table 1 summarizes clinical data and the main APO recorded. Systemic lupus erythematous (SLE) was the leading diagnosis followed by spondyloarthritis (SpA) and rheumatoid arthritis (RA). Antiphospholipid syndrome (APS) was diagnosed in 49 (13.9%) preg. We documented 284 (78%) live births (9 twin preg), 32 (10%) miscarriages, 7 (2%) elective abortions, 2 stillbirths (0.6%) and 2 ectopic preg; 35 (10%) of the overall preg were lost to follow up before delivery. Miscarriages occurred predominantly in pts with APS (34%). Fetal growth restriction (FGR) was recorded in 6% of preg, more than 1/3 of those in pts with APS. Preeclampsia (PE) complicated a total of 10 (4%) preg, 3 of those with superimposed HELLP syndrome, with SLE and APS accounting for 60% of the cases. Preterm births (15.5%) occurred mainly in APS, SLE and juvenile idiopathic arthritis (JIA) pts. Neonatal lupus ensued in 3 (3.8%) preg positive for anti-Ro/La antibodies. No neonatal deaths were recorded. SpA and RA represented the diseases which flared the most considering both pregnancy and the postpartum period. Table 1. Pregnancy outcomes by disease Main diagnosis N, % Gest age at delivery (weeks) Miscarr FGR PE Preterm births Flares in preg Flares in PP SLE 116, 32.9 38±2.3 13/110, 11.8 6/82, 7.3 5/78, 6.4 15/76, 21.1 16/92, 17.4 5/79, 6.3 SpA 60, 17 39±2.6 2/55, 3.6 5/44, 11.4 1/45, 2.2 5/40, 12.5 18/40, 45 5/23, 21.7 RA 51, 14.4 39±1.2 6/49, 12.2 1/35, 2.9 1/33, 3 1/29, 3.4 10/37, 27 7/30, 23.3 Vasculitis 25, 7.1 38±1.8 1/24, 4.2 1/21, 4.8 0/19, 0 4/21, 19 7/23, 30.4 2/17, 11.8 Primary APS 22, 6.2 38±1.6 3/22, 13.6 1/17, 5.9 1/16, 6.3 2/16, 12.5 NA NA JIA 17, 4.8 38±2.5 1/17, 5.9 0/12, 0 0/11, 0 4/12, 33.3 2/13, 15.4 1/8, 12.5 UCTD 15, 4.2 39±1.5 2/15, 13.3 0/11, 0 1/10, 10 1/11, 9.1 0/15, 0 0/15, 0 Primary Sjögren Syndrome 12, 3.4 39±1.4 0/11, 0 0/9, 0 0/10, 0 1/9, 11.1 1/8, 12.5 0/6, 0 Others 35, 9.9 38±2.3 4/31, 12.9 2/20, 10 1/18, 5.6 3/18, 16.7 4/27, 14.8 1/22, 4.5 Total 353, 100 38±2.2 32/334, 9.6 16/251, 6.4 10/240, 4.2 36/232, 15.5 58/255, 22.7 21/200, 10.5 Secondary diagnosis APS 27 37±2.7 8/26, 30.8 5/16, 31.3 2/12, 16.7 5/15, 33.3 NA NA Sjögren Syndrome 9 37±2.5 1/9, 11.1 1/7, 14.3 0/7, 0 3/6, 50 NA NA Legend - gest: gestational; miscarr: miscarriages; NA – not applicable; PP: postpartum; preg: pregnancy; UCTD - Undifferentiated connective tissue disease. Continuous variables are presented as mean±SD. Categorical variables as n/mN, % - modified(m)N stands for total N – (not applicable+missing data); “Others” accounts for diagnosis with N≤6, such as APS non criteria, mixed connective tissue disease, myositis, overlap syndromes, Still’s disease and systemic sclerosis. Conclusion: In pregnant women with RD, it is of vital importance to be aware of the increased risk for APO. In our cohort, APS and SLE were the conditions most associated with APO, while SpA and RA were responsible for most maternal flares. Nevertheless, the majority of these pts, surveilled by a multidisciplinary team, had successful gestations. Disclosure of Interests: None declared