Clinical presentation of autoimmune disorders in pregnancy

Authors

  • Neha Singhal Department of Obstetrics and Gynecology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
  • Alka S. Gupta Department of Obstetrics and Gynecology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
  • Madhva Prasad Department of Obstetrics and Gynecology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India http://orcid.org/0000-0001-5507-7812

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20175250

Keywords:

ANA positivity, Aspirin, Autoimmune disorders, Heparin, Pregnancy

Abstract

Background: Autoimmune disorders have a significant impact over the health of an individual. This heterogenous group of disorders affects pregnancy in a multitude of ways. Pregnancies with autoimmune disorders are usually cared for by a multidisciplinary team of doctors.

Methods: Pregnancies with autoimmune disorders were studied over a one-year period in one unit of a medical college teaching hospital set up. Obstetric and neonatal outcomes were studied.

Results: Ten patients were studied. Average age was 29.9 years. Majority presented in early second trimester. Eight patients were ANA positive. Two patients had antiphospholipid antibody syndrome, for whom low molecular weight heparin was helpful. Hypothyroidism was seen in two patients. Bad obstetric history was seen in most patients. Successful neonatal outcome was seen in six patients. One patient had Evans syndrome. There were no maternal mortalities. There was one perinatal mortality.

Conclusions: Autoimmune disorders in pregnancy when managed in a tertiary care centre with multidisciplinary approach can result in good obstetric and neonatal outcomes.

References

Cooper GS, Bynum MLK, Somers EC. Recent insights in the epidemiology of autoimmune diseases: improved prevalence estimates and understanding of clustering of diseases. J Autoimmun. 2009;33(3-4):197-207.

Singh NK, Agrawal A, Singh MN, Kumar V, Godhra M, Gupta A et al. Prevalence and pattern of antiphospholipid antibody syndrome in a hospital based longitudinal study of 193 patients of systemic lupus erythematosus. J Assoc Physicians India. 2013 Sep;61(9):623-6.

Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum. 2006 Mar;54(3):899-907.

Kothari R, Digole A, Kamat S, Nandanwar YS, Gokhale Y. Reproductive Health in Systemic Lupus Erythematosus, An experience from Government Hospital in Western India. J Assoc Physicians India. 2016 Dec;64(12):16-20.

Oktem O, Guzel Y, Aksoy S, Aydin E, Urman B. Ovarian function and reproductive outcomes of female patients with systemic lupus erythematosus and the strategies to preserve their fertility. Obstet Gynecol Surv. 2015 Mar;70(3):196-210.

Jones A, Giles I. Fertility and pregnancy in systemic lupus erythematosus. Indian J Rheumatol. 2016;11Suppl S2:128-34.

Clowse MEB, Wallace DJ, Weisman M, James A, Criscione-Schreiber LG, Pisetsky DS. Predictors of preterm birth in patients with mild systemic lupus erythematosus. Ann Rheum Dis. 2013 Sep;72(9):1536-9.

Sakthiswary R, Rajalingam S, Norazman MR, Hussein H. Antinuclear antibodies predict a higher number of pregnancy loss in unexplained recurrent pregnancy loss. Clin Ter [Internet]. 2017;166(2):e98-101.

Arkema EV, Palmsten K, Sjöwall C, Svenungsson E, Salmon JE, Simard JF. What to expect when expecting with systemic lupus erythematosus (SLE): a population-based study of maternal and fetal outcomes in SLE and Pre-SLE. Arthritis Care Res (Hoboken). 2016 Jul;68(7):988-94.

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

Sciascia S, Hunt BJ, Talavera-Garcia E, Lliso G, Khamashta MA, Cuadrado MJ. The impact of hydroxychloroquine treatment on pregnancy outcome in women with antiphospholipid antibodies. Am J Obstet Gynecol. 2016;214(2):273.e1-273.e8.

Andreoli L, Bertsias GK, Agmon-Levin N, Brown S, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017 Mar; 76(3):476-85.

Erlinger S. Intrahepatic cholestasis of pregnancy: A risk factor for cancer, autoimmune and cardiovascular diseases? Clin Res Hepatol Gastroenterol. 2016 Apr; 40(2):139-40.

Surita FG de C, Parpinelli MA, Yonehara E, Krupa F, Cecatti JG. Systemic lupus erythematosus and pregnancy: clinical evolution, maternal and perinatal outcomes and placental findings. Sao Paulo Med J. 2007 Mar;125(2):91-5.

Tan LK, Tan HK, Lee CT, Tan ASA. Outcome of pregnancy in Asian women with systemic lupus erythematosus: experience of a single perinatal centre in Singapore. Ann Acad Med Singapore. 2002 May;31(3):290-5.

Vinet E, Pineau CA, Scott S, Clarke AE, Platt RW, Bernatsky S. Increased congenital heart defects in children born to women with systemic lupus erythematosus: results from the offspring of systemic lupus erythematosus mothers registry study. Circulation. 2015 Jan;131(2):149-56.

Nause S, Spiegler J, Weichert J, Hartge D. Therapeutic management of evans syndrome in a pregnancy with maternal systemic lupus erythematosus. Z Geburtshilfe Neonatol. 2015 Jun;219(4):190-2.

Vinet É, Pineau CA, Clarke AE, Scott S, Fombonne É, Joseph L, et al. Increased Risk of Autism Spectrum Disorders in Children Born to Women With Systemic Lupus Erythematosus: Results From a Large Population-Based Cohort. Arthritis Rheumatol. 2015 Dec;67(12):3201-8.

Galappatthy P, Jayasinghe JDD, Paththinige SC, Sheriff RMH, Wijayaratne LS. Pregnancy outcomes and contraceptive use in patients with systemic lupus Erythematosus, rheumatoid arthritis and women without a chronic illness: a comparative study. Int J Rheum Dis. 2017 Jun;20(6):746-54.

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Published

2017-11-23

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Original Research Articles