Review of 113 cases of autoimmune disorders in pregnancy
Keywords:Autoimmune disorder, Fetal complications, Immunomodulators, Maternal complications, Pregnancy outcome, Pre-conceptional counseling
Background: Autoimmune disorders are chronic multisystem disorders affecting women of their reproductive age. Pregnancy among these women is complicated by the disease itself. Flaring up of disease, uteroplacental insufficiency due to vasculitis and drugs used for treatment are main reason for unfavourable pregnancy outcomes. The objective of this study was to analyze the pregnancy complications and outcome among 113 cases of autoimmune disorders.
Methods: This study is a retrospective analysis of case records of pregnant women with autoimmune disorders. This study was conducted at PSG IMSR and Hospital, Coimbatore, and Tamil Nadu from July 2012 to June 2018. The case sheets were retrieved from medical record department and the details such as type of disease, maternal age, parity, status of disease at conception, treatment taken during pregnancy, maternal complications and fetal complications were collected and analyzed.
Results: During 6-year period there were 113 pregnant women with autoimmune disorders, and they were studied of their previous and present pregnancy outcome. The disease incidence was 7.01% per 1000 deliveries. 40.7% were less than 25 years age group and 71.6% were multigravidae. We had forty-one patients (36%) who were positive for APLA syndrome which were the maximum number of patients with auto immune disorder in pregnancy and 37 patients (32.7) with SLE. We had significant numbers of maternal and fetal complications for common disorders. Most of the rare auto immune disorders were diagnosed before pregnancy and these pregnancies were managed by multi-disciplinary approach, and continued on immunomodulators throughout pregnancy, hence maternal and fetal complications were less for them.
Conclusions: Adequate pre-conceptional counseling, vigilant monitoring during pregnancy and post-partum will avoid pregnancy related complications and have favorable outcomes.
Sarah M, Mark Q, Paul E, Chapter 32 – Rheumatoid arthritis Editors: Noel R. Rose, Ian R. Mackay, The Autoimmune Diseases. 4th Ed, Academic press; 2006:417-436.
Cooper G, Bynum M, Somers E. 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.
Perricone C, Carolis C, Perricone R. Pregnancy and autoimmunity: a common problem. Best Pract Res Clin Rheumatol. 2012;26(1):47-60.
Andreoli L, Fredi M, Nalli C, Reggia R, Lojacono A, Motta M et al. Pregnancy implications for systemic lupus erythematosus and the antiphospholipid syndrome. J Autoimmun. 2012;38(2-3):197-208.
Mecacci F, Pieralli A, Bianchi B, Paidas MJ. The impact of autoimmune disorders and adverse pregnancy outcome. Semin Perinatol. 2007;31(4):223-6.
Wilson WA, Gharavi AE, Koike T. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arth Rhe. 1999;42:1309-11.
Miyakis S, Lockshin MD, Atsumi T. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295-306.
Hughes GR. The antiphospholipid syndrome: ten years on. Lancet (London, England). 1993;342:341-4.
Lockshin MD, Kim M, Laskin Ca. Prediction of adverse pregnancy outcome by the presence of lupus anticoagulant, but not anticardiolipin antibody, in patients with antiphospholipid antibodies. Arth Rh. 2012;64:2311-8.
Wijeyaratne CN, Galappaththi SLA, Palipane E, Jayawardane DBIA, Dodampahala SH, Tudawe MN, et al. Pregnancy outcomes of antiphospholipid syndrome: In a low resource South Asian setting. Med. 2016;9(2):83-9.
Cooper GS, Gilbert KM, Greidinger EL. Recent advances and opportunities in research on lupus: environmental influences and mechanisms of disease. Environ Health Perspect. 2008;116:695-702.
Clowse MEB, Jamison M, Myers E. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 2008;199:1-12.
Jakobsen IM, Helmig RB, Stengaard-Pedersen K. Maternal and foetal outcomes in pregnant systemic lupus erythematosus patients: an incident cohort from a stable referral population followed during 1990-2010. Scand J Rheumatol. 2015;44:377-84.
Eman Aly, Hussein Aly, Riyad RM, Mokbel AN. Pregnancy outcome in patients with systemic lupus erythematosus: a single center study in the high-risk Pregnancy unit. Middle East Fert Society J. 2016;21:168-74.
Mandal D, Mandal S, Dattaray C, Banrrjee D, Ghosh P, Ghosh A, et al. Takayasu arteritis in pregnancy: an analysis from eastern India. Arch Gynecol Obstet. 2012;285(3):567-71.
Jennette CJ, Milling DM, Falk RJ. Vasculitis affecting the skin. Arch Dermatol. 1994;130:899-906.
Robert F, Walter R, Sator PG, Gschnait F, Breier F. Schönlein-Henoch purpura during pregnancy with successful outcome for mother and newborn BMC Dermatol. 2002;2:1.
Gatto M, Iaccaino L, Canova M, Nalotto L, Ramonda R. Pregnancy and vasculitis; a systematic review of the literature. Autoimmun Rev. 2012;11:A447-59.
Wyszynski DF, Carman WJ, Cantor AB, Graham JM, Kunz LH, Slavotinek AM, et al. Pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura. J Preg. 2016:Article id 8297407.
Yassaee F, Eskandari R, Amiri Z. Pregnancy outcomes in women with idiopathic thrombocytopenic purpura. Iran J Reprod Med. 2012;10(5):489-92.
De Man YA, Hazes JMW, Van Der Heide H. Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: Results of a national prospective study. Arth Rhe. 2009;60:3196-206.
Bharti B, Lee SJ, Lindsay SP. Disease severity and pregnancy outcomes in women with rheumatoid arthritis: Results from the organization of teratology information specialists autoimmune diseases in pregnancy project. J Rheumatol. 2015;42:1376-82.
Hughes RA, Cornblath DR. GuillainBarre’ syndrome. Lancet. 2005;366:1653-66.
Vijayaraghavan J, Vasudevan D, Sadique N, Rajeswari KS, Pondurangi M, Jayshree A. Rare case of Guillain-Barre’ syndrome with pregnancy. J Indian Med Assoc. 2006;104:269-70.
Coles A. Multiple sclerosis. Lancet. 2008;372:1502-17.
Jalkanen A, Alanen A, Airas L. The finnish multiple sclerosis and pregnancy study group. Pregnancy outcome in women with multiple sclerosis – results from a prospective nationwide study in Finland. Mult Scler. 2010;16:950-5.
Mueller BA, Zhang J, Critchlow CW. Birth outcomes and need for hospitalization after delivery among women with multiple sclerosis. Am J Obstet Gynecol. 2002;186:446-52.
Dahl J, Myhr KM, Daltveit AK, Hoff JM, Gilhus NE. Pregnancy, delivery, and birth outcome in women with multiple sclerosis. Neurol. 2005;65:1961-3.
Siamopoulou-Mavridou A, Manoussakis MN, Mavridis AK, Moutsopoulos HM. Outcome of pregnancy in patients with autoimmune rheumatic disease before the disease onset. Ann Rheum Dis. 1988;47(12):982-7.
Carvalheiras G, Faria R, Braga J, Vasconcelos C. Fetal outcome in autoimmune diseases. Autoimmun Rev. 2012;11(6-7):A520-30.
Sandhya P, Jeyaseelan L, Scofield RH, Danda D. Clinical characteristics and outcome of primary Sjogren’s syndrome: a large Asian Indian cohort. Open Rheumatol J. 2015;9:36-45.
Brucato A, Cimaz R, Caporali R, Ramoni V, Buyon J. Pregnancy outcomes in patients with autoimmune diseases and anti-Ro/SSA antibodies. Clin Rev Allergy Immunol. 2011;40(1):27-41.
Lao TT. Thyroid disorders in pregnancy. Curr Opin Obstet Gynecol. 2005;17:123-7.
Stephansson O, Larsson H, Pedersen L. Congenital abnormalities and other birth outcomes in children born to women with ulcerative colitis in Denmark and Sweden. Inflamm Bowel Dis. 2011;17(3):795-801.
Kujovich JL. Von Willebrand disease and pregnancy. J Thromb Haemost. 2005;3(2):246-53.