AB0826 IMPORTANCE OF PRECONCEPTION CARE AND PLANNING FOR PREGNANCY IN WOMEN OF CHILDBEARING AGE COMPLICATED WITH CONNECTIVE TISSUE DISEASES
Authors: H. Shimada, R. Wakiya, M. Mahmoud Fahmy Mansour, S. Nakashima, M. Kato, T. Miyagi, K. Sugihara, Y. Ushio, T. Kameda, H. Dobashi
Journal: Annals of the Rheumatic Diseases (2021)

Background: Previous reports showed that connective tissue disease (CTD) have a high risk for adverse pregnancy outcomes (APOs) such as preterm birth, light-for-date, or preeclampsia 1) . It was revealed that these APOs were associated with high disease activity or treatment agents, particularly in glucocorticoid 2) . Some patients, who have no or insufficient preconception care and became unplanned pregnant, exacerbate the underlying disease, and lead to disappointing pregnancy outcomes. Therefore, preconception care and planning for pregnancy is very important to control disease activities and manage the appropriate treatment agents, including glucocorticoid, immunosuppressants, biologics, hydroxychloroquine, and anticoagulants 3) . Objectives: We investigate whether the presence or absence of preconception care before pregnancy affects clinical disease course and pregnancy outcomes. Methods: We examined 200 CTD women who delivered their newborns in our institution from March 2006 to January 2021. We analyzed the association between preconception care and the clinical course of underlying diseases during pregnancy or pregnancy outcomes. Results: Of all 200 cases, 133 (55.9%) cases had preconception care in our institution, while the others had no or insufficient preconception care. We showed the comparison of treatment agents and pregnancy outcomes between the cases with and without preconception care in Table 1. There was no significant difference in the rate of glucocorticoid use and the mean prednisolone dose during pregnancy between these two groups. However, the rate of increased dose of glucocorticoid or pulse therapy was significantly higher in the cases without preconception care. As for pregnancy outcomes, there was no significant difference in the live birth rate. On the other hand, the gestational weeks at delivery were significantly shorter, and the rate of preterm birth was higher in the cases without preconception care. In addition, the rate of the hospitalization of neonatal intensive care unit (NICU) was also significantly higher in the cases without preconception care. Conclusion: We revealed that preconception care before pregnancy reduced the need for intensified treatment such as increasing dose of glucocorticoid or pulse therapy. The rate of preterm birth and NICU hospitalization was also shown to decrease. Therefore, it is important for our rheumatologists to provide an appropriate preconception care for CTD women of childbearing age and to make a plan for pregnancy. References: [1]Tsuda S, Sameshima A, Sekine M, Kawaguchi H, Fujita D, Makino, et al. Mod Rheumatol 2019:24;1-10. [2]Clowse ME, Magder LS, Petri M. J Rheumaotol 2011;38:1012-1016. [3]Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, et al. Arthritis Care Res 2020;72:461-488. Table 1. Comparison of treatment agents and pregnancy outcomes between the cases with and without preconception care Preconception care (+) (n=113) Preconception care (-) (n=89) P value Treatment agents during pregnancy Glucocorticoid use (n (%)) 64 (56.6) 50 (56.2) 1.00 Mean glucocorticoid dose (mg/day) 6.3±3.9 8.4±6.1 0.09 Dose-up of glucocorticoid (n (%)) 11 (9.7) 26 (29.2) &lt;0.01* Glucocorticoid pulse therapy (n (%)) 0 (0) 8 (9.0) 0.01* Immunosuppressant (n (%)) 14 (12.5) 4 (4.5) 0.08 Hydroxychloroquine (n %)) 7 (6.2) 6 (6.7) 1.00 Anticoagulant therapy (n (%)) 21 (18.8) 16 (17.8) 1.00 Pregnancy outcome Spontaneous abortion (n (%)) 8 (7.1) 6 (6.7) 1.00 Live birth (n (%)) 100 (88.5) 78 (87.6) 1.00 Gestational weeks at delivery (week) 38.7±1.4 37.3±3.5 0.01* Birth weight of newborn (gram) 2888.8±453.7 2678.4±732.6 0.25 Adverse pregnancy outcomes (n (%)) 26 (26.0) 28 (35.0) 0.20 Preterm birth (n (%)) 5 (5.0) 19 (23.8) &lt;0.01* Light-for-date (n (%)) 10 (10.0) 9 (11.3) 0.81 Hypertensive disorder (n (%)) 5 (5.0) 8 (10.0) 0.25 NICU management (n (%)) 13 (13.0) 24 (30.0) &lt;0.01* Disclosure of Interests: None declared