Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Autoimmune Diseases Pregnancy Clinic: A Three Year Experience
Martinez-Dubois1, Cristina, Lopez-Hoyos Sr.1, Marcos, del Barrio Sr.1, Rafael, Alvarez-Rodriguez2, Lorena, Agudo Sr.2, Mario, Rueda Sr.1, Javier, Blanco Sr.1, Ricardo
Women with systemic autoimmune diseases face significant risks during the pregnancy, but the control of these patients in a multidisciplinary setting can improve outcome for women and their babies. The aim of the present study is to describe the 3 year experience of a multidisciplinary clinic at a university hospital
We collected data from patients referred to our autoimmune diseases pregnancy clinic (ADPC) because of suspicion of an autoimmune disease and pregnancy.
The mean age of the patients was 31.8±5.6 years. Patients were mainly referred from the Obstetrics (49%) and Rheumatology departments (16%). After evaluation, patients were divided in several groups: a) Antiphospholipid syndrome (APS): 43 patients (32%); b) serological positive anti-phospholipid antibodies (APL) without fulfilling APS criteria: 30 patients (22%); c) suggestive clinical picture without APL confirmation in 17 (13%); d) patients with other autoimmune conditions different from APS (including 10% of SLE); e) coagulopathies (6%), and f) no evidence of disease in 42 (32%). Isolated obstetric pathology was observed in 71.2% of the patients, whereas 8.3% had associated thrombotic episodes and 2.3% thrombopenia. The most frequent reason for referral were early pregnancy loss (< 10 weeks) in 52.7% and late pregnancy loss (>10 weeks) in 28%, although in one third of the patients there were more than one manifestation. With regard to APL, isolated anti-cardiolipin antibodies were found in 26.1% of patients, isolated anti-beta 2 glycoprotein I in 13.6%, and isolated lupus anticoagulant in 4%. The combination of the three types of APL at the same time was only found in 7.2% of patients. Overall, 92% of the patients were treated with aspirin, and in 38.1% it was combined with low-weight molecular heparin. Only a minority of the patients received other treatments: antimalarials (9.3%), corticosteroids (5%) or azathioprine (2.8%). During the 3-year period a total of 139 pregnancies (133 patients) were followed and treated in our unit. 85. 6% of these pregnancies ended in a successful delivery. Previously, these patients had a total of 257 pregnancies with a 25.7% of successful deliveries.
The experience of our ADPC supports the utility of dedicated clinics in the management of autoimmune diseases during pregnancy. APS is the most frequent disease attended in this type of unit. In this setting, the frequency of seronegative and serological but not clinical APS is rather high and these subtypes of patients not fulfilling the Sidney criteria must be taken into account.
Grants: MSC-Instituto de Salud Carlos III (PI050475/PI080098), IFIMAV, and Roche (Spain).
To cite this abstract, please use the following information:
Martinez-Dubois, Cristina, Lopez-Hoyos Sr., Marcos, del Barrio Sr., Rafael, Alvarez-Rodriguez, Lorena, Agudo Sr., Mario, Rueda Sr., Javier, et al; Autoimmune Diseases Pregnancy Clinic: A Three Year Experience [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1286