Connective tissue disorders in pregnancy: maternal and fetal perspective

Authors

  • Nehul Jha Department of Obstetrics and Gynecology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
  • Hemangi K. Chaudhari Department of Obstetrics and Gynecology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20200887

Keywords:

Antiphospholipid antibody syndrome, Autoimmune diseases, Connective tissue diseases, Intrauterine fetal death, Rheumatoid arthritis, Scleroderma, Sjogrens syndrome, Systemic lupus erythematosus

Abstract

Background: The objective of this study was to study maternal and fetal outcome in connective tissue disorders in pregnancy.

Methods: This was a retrospective type of observational study done in department of obstetrics and gynecology and department of rheumatology at a King Edward Memorial hospital over a period of 1.5 years. 48 women were included in this study after informed consent. All these women presented with collagen disorders to ANC outpatient department or to rheumatology outpatient department or in emergency. All postpartum patients having connective tissue disorders not recruited during ANC were also included in this study after taking their written, informed and valid consent.

Results: Connective tissue disorders are associated with multiple voluntary and involuntary abortions as well as intrauterine fetal deaths. Even in those women having live births, many undergo cesarean sections due to various indications like fetal distress, poor biophysical profile, non-reassuring non stress test etc. Neonates born to mothers with connective tissue disorders are growth restricted and many of them need intensive care admission. Also, these women were found to have multiple associated medical comorbidities in pregnancy.

Conclusions: The data collected and the results arrived upon should help contribute significant literature regarding collagen disorders in pregnancy and help in better fetal and maternal management during pregnancy.

References

Manole C, Inimioara MC, Isabela S, Camelia DV. Manifestations of systemic lupus erythematosus. Maedica (Buchar). 2011;6(4):330-6.

Carcassi U, Passiu G. Collagenopathic cardiopathies. II Cattedra di Reumatologia; 1991;6(4 Pt 2):483-90.

Clowse ME. Lupus activity in pregnancy. Rheum Dis Clin North Am. 2007;33(2):237-52.

Petri M, Howard D, Repke J. Frequency of lupus flare in pregnancy. The Hopkins lupus pregnancy center experience. Arth Rheumat. 1991;34(12):1538-45.

Urowitz MB, Gladman DD, Farewell VT, Stewart J, McDonald J. Lupus and pregnancy studies. Arth Rheumat. 1993;36(10):1392-7.

Molad Y, Borkowski T, Monselise A, Ben-Haroush A, Sulkes J, Hod M, et al. Maternal and fetal outcome of lupus pregnancy: a prospective study of 29 pregnancies. Lupus. 2005;14(2):145-51.

Carmona F, Font J, Cervera R, Muñoz F, Cararach V, Balasch J, et al. Obstetrical outcome of pregnancy in patient with systemic Lupus erythematosus. A study of 60 cases. Eur J Obstet Gynecol Reprod Biol. 1999;83(2):137-42.

Mankee A, Petri M, Magder LS. Lupus anticoagulant, disease activity and low complement in the first trimester are predictive of pregnancy loss. Lupus Sci Med. 2015;2:e000095.

Vengetesh PM, Hebbar S, Rai L. Autoimmune diseases in pregnancy: maternal and fetal outcomes. Int J Reprod Contracept Obstet Gynecol. 2015;4(1):9-14.

Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with Systemic Lupus Erythematosus and Lupus Nephritis. Clin J Am Soc Nephrol. 2010;5(11):2060-8.

Gladman DD, Tandon A, Ebanez D. The effect of lupus nephritis on pregnancy outcome and maternal and fetal complications. J Rheumatol. 2010;37(4):754-8.

Barnabe C, Faris PD, Quan H. Canadian Pregnancy Outcomes in Rheumatoid Arthritis and Systemic Lupus Erythematosus. Int J Rheumatol. 2011:2011.

Clowse MEB, McDaniel G, Eudy AM. Pregnancy in Rheumatoid Arthritis: a retrospective study. Clin Rheumatol. 2018;37(3):789-94.

Persellin RH. The effect of pregnancy on rheumatoid arthritis. Bull Rheum Dis. 1976-1977;27(9):922-7.

Ostensen M. The influence of pregnancy on blood parameters in patients with rheumatic disease. Scand J Rheumatol. 1984;13(3):203-8.

Bharti B, Lee SJ, Lindsay SP, Wingard DL, Jones KL, Lemus H, et al. 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.

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(9):1428-32.

Aboubakar M, Klikpezo R, Tognifode M, Denakpo JL, Zouari F. Pregnancy outcome of women with antiphospholipid syndrome, a retrospective descriptive case study. Gynecol Obstet (Sunnyvale). 2017;7(435):2161-0932.

Davis SM, Branch DW. Thromboprophylaxis in pregnancy: Who and How? Obstet Gynecol Clin North Am. 2010:37(2):333-43.

Empson M, Lassere M, Craig J, Scott J. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev. 2005;(2):CD002859.

Sisamopoulou-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.

Skopouli FN, Papanikolaou S, Malamou-Mitsi V, Papanikolaou N, Moutsopoulos HM. Obstetric and gynecological profile in patients with primary Sjögren’s syndrome. Ann Rheum Dis. 1994;53(9):569-73.

Carvalheiras G, Faria R, Braga J, Vasconcelos C. Fetal outcome in autoimmune diseases. Autoimmun Rev. 2012;11(6-7):A520-30.

Hussein SZ, Jacobsson LT, Lindquist PG, Theander E. Pregnancy and fetal outcome in women with primary Sjogren’s syndrome compared with women in the general population: a nested case-control study. Rheumatol (Oxford). 2011;50(9):1612-7.

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.

Rosenthal D, Druzin M, Chin C, Dubin A. A new therapeutic approach to the fetus with congenital complete heart block: preemptive, targeted therapy with dexamethasone. Obstet Gynecol. 1998;92(4 Pt 2):689-91.

Taraborelli M, Brucato A, Airò P, Bajocchi G, Bellisai F, Biasi D, et al. Successful pregnancies but a higher risk of preterm births in patients with systemic sclerosis: an Italian multicenter study. Arth Rheumat. 2012;64(6):1970-7.

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Published

2020-02-27

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Original Research Articles