Autoimmune diseases in pregnancy: maternal and fetal outcomes

Authors

  • Pavithra M. Vengetesh Department of Obstetrics & Gynaecology, KMC Manipal, Manipal University, Manipal, Karnataka, India
  • Shripad Hebbar Department of Obstetrics & Gynaecology, KMC Manipal, Manipal University, Manipal, Karnataka, India
  • Lavanya Rai Department of Obstetrics & Gynaecology, KMC Manipal, Manipal University, Manipal, Karnataka, India

Keywords:

Autoimmune diseases, SLE in pregnancy, Antiphospholipid antibody syndrome, Mixed connective tissue diseases, Recurrent pregnancy loss

Abstract

Background: The aim of this study was to assess the impact of autoimmune connective tissue disorders on the outcomes of pregnancy and the influence of treatment on pregnancy.  

Methods: Thirty-seven antenatal patients with autoimmune connective tissue diseases, comprising of Systemic Lupus Erythematosus (SLE), primary antiphospholipid antibody syndrome (APS), Mixed Connective Tissue Diseases (MCTD), ankylosing spondylitis and Takayasu arteritis were analysed.

Results: Multigravidas constituted 89.4% and were associated with bad obstetric history. Before diagnosis and treatment, serious maternal complications of eclampsia and thromboembolism were observed in patients with SLE and APS. The live birth rates were 9% and 2.4% respectively in patients with SLE and APS. With appropriate treatment- aspirin, heparin and immunosuppressant, the live birth rates were raised to 70% in SLE and 100% in APS patients. Investigation for autoimmune disease in recurrent pregnancy loss is important. A rare association between MCTD and congenital anomaly - Rhizomelic chondrodysplasia punctata was observed. Preeclampsia, gestational diabetes, fetal growth restriction and preterm labour were the common complications noted.  

Conclusions: Active disease at onset of pregnancy, presence of Anti-ds DNA antibodies and secondary APS were strong predictors of poor pregnancy outcomes among patients with SLE. Vigilant monitoring during pregnancy is required for favourable outcomes.

References

Hochberg MC. Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.

Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295-306.

Buyon JP, Kalunian KC, Ramsey-Goldman R, Petri MA, Lockshin MD, Ruiz-Irastorza G, et al. Assessing disease activity in SLE patients during pregnancy. Lupus. 1999;8(8):677-84.

Clowse MEB, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 2008;199:127.e1-6.

Ruiz-Irastorza G, Khamashta MA, Castellino G, ughes GR. Systemic lupus erythematosus. Lancet. 2001;357:1027-32.

Molad Y, Borkowski T, Monselise A, Ben-Haroush A, Sulkes J, Hod M, et al. Maternal fetal outcomes of lupus pregnancy: a prospective study of 29 pregnancies. Lupus. 2005;14:145-51.

Chandran V, Aggarwal A, Misra R. Active disease during pregnancy is associated with poor foetal outcome in Indian patients with systemic lupus erythematosus. Rheumatol Int. 2005 Dec;26(2):152-6.

Al Arfaj AS, Khalil N. Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus. 2010 Dec;19(14):1665-73.

Empson M, Lassere M, Craig JC, Scott JR. Recurrent pregnancy loss with antiphospolipid antibody: a systematic review of therapeutic trials. Obstet Gynecol. 2002;99:135-44.

Basiri Z, Gholyaf M, Faridnia M, Nadi E, Bairanvand M. The prevalence of anticardiolipin antibody in patients with systemic lupus erythematosus and its association with clinical manifestations. Acta Med Iran. 2013;51(1):35-40.

Cervera R, Khamashta MA, Shoenfeld Y, Camps MT, Jacobsen S, Kiss E, et al. Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis. 2009;68:1428-32.

Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA. Antiphospholipid syndrome. Lancet. 2010;376:1498-509.

Figueiredo SS, Araujo JS, Kozan JEM, Santos NCL, Tanganeli V. Rhizomelic chondrodysplasia punctata: a case report and brief literature review. Radiol Bras. 2007;40:69-72.

Chung L, Flyckt RL, Colon I, Shah AA, Druzin M, Chakravarthy EF. Outcome of pregnancies complicated by systemic sclerosis and mixed connective tissue disease. Lupus. 2006;15(9):595-9.

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Published

2017-02-03

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Original Research Articles