A recent publication in Rheumatic & Musculoskeletal Diseases MD Open sheds light on the real-world management of pregnancy among a diverse group of women with various autoimmune rheumatic diseases (ARDs). The P-RHEUM.it study suggests that employing a comprehensive set of measures, similar to a ‘toolkit’ approach, can effectively navigate pregnancy in this patient subset. Key factors such as preconception counseling and a treat-to-target strategy using pregnancy-compatible medications likely played significant roles in mitigating disease-related risks. As a result, instances of disease flares were minimal, and both maternal and neonatal outcomes were favorable.
The five-year study conducted by Andreoli and colleagues (2018-2023) involved 866 pregnancies in 851 women with various autoimmune rheumatic diseases (ARDs) across 29 rheumatology centres. Systemic lupus erythematosus was the most prevalent condition, accounting for 19.6% of cases. Maternal flares occurred in 15.6% of cases, with 6.1% resulting from assisted reproduction techniques. Miscarriages accounted for 7% of pregnancies, and 1.3% were electively terminated. Obstetrical complications affected 30.1% of pregnancies, including 2.3% with pre-eclampsia. Two cases of congenital heart block were observed in pregnancies with anti-Ro/SSA antibodies. Treatment included glucocorticoids (28.2%), hydroxychloroquine (44.8%), and biological disease-modifying drugs (14.1%). Live births were 91.7%, with 0.5% perinatal deaths. Small-for-gestational-age occurred in 3.9% of newborns, and 21.4% experienced perinatal complications. Maternal breastfeeding was practiced by 46.7% of neonates. Additionally, 52.4% of women completed the Edinburgh Postnatal Depression Scale, with 21.5% indicating emotional distress.
The onset of ARDs is more common in women of childbearing age, underscoring the vital importance of addressing reproductive concerns within the spectrum of ARD management. While treatment approaches for ARD have markedly advanced in recent decades, they have also introduced new complexities. The integration of novel antirheumatic drugs during pregnancy and lactation may present newer challenges that necessitate careful consideration and specialized care.
The study highlights a real-world approach to managing pregnancies in patients with ARDs. Key elements include pregnancy planning, compatible medications, stable disease control, and close monitoring, resulting in low disease flare rates and outcomes comparable to the general obstetric population. The study findings offer important guidance for healthcare professionals involved in preconception counseling, emphasizing the significance of a personalized and multidisciplinary approach to treatment. Stratifying risks and tailoring treatments can help in reducing disease-related complications, contributing to successful maternal and neonatal outcomes.
References
Andreoli L, Gerardi MC, Gerosa M, Rozza D, Crisafulli F, Erra R, et al. 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. RMD Open. 2024 Apr 24;10(2):e004091.