Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Prevalence and Significance of Previously Undiagnosed Rheumatic Diseases in Pregnancy.
Ramoni1, Véronique, Caporali1, Roberto, Spinillo2, Arsenio, Beneventi2, Fausta, Simonetta2, Margherita, Locatelli2, Elena, Cavagnoli2, Chiara
Rheumatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
IRCCS Policlinico San Matteo Foundation, Pavia, Italy
The objective of this study is to evaluate the rates of previously undiagnosed rheumatic diseases during the first trimester of pregnancy and their impact on pregnancy outcome.
Pregnant women attending the ultrasonography clinic of our Hospital for their first-trimester ultrasound scan were screened with a two-steps approach using a self administered 10 items questionnaire and subsequent testing for autoantibodies (antinuclear, anti-double-stranded DNA, anti-extractable nuclear antigen, anticardiolipin, anti-beta2-glycoprotein I antibodies and lupus anticoagulant) and evaluation by a rheumatologist. Overall, complications of pregnancy evaluated included fetal loss, preeclampsia, gestational diabetes, fetal growth restriction, delivery less than 34 weeks, neonatal resuscitation and admission to neonatal intensive care unit. Pregnancies were prospectively followed by Rheumatologists and Obstetricians to assess fetal and maternal outcomes.
During a 5-year period (May 2005 to April 2010) out of the 2458 subjects screened, 291 (11.8%) patients answered positively to the questionnaire and among them 143 (49.2%) tested positive for autoantibodies. After rheumatologic evaluation we identified 62 (2.5%) women with a diagnosis of undifferentiated connective tissue disease (UCTD) and 24 (0.98%) with a major autoimmune rheumatic disease. The prevalences were 7 (0.28%) for systemic lupus erythematosus and Sjogren's syndrome, 6 (0.24 %) for rheumatoid arthritis, 3 (0.12%) for anti-phospholipid syndrome and 1 (0.04%) for systemic sclerosis respectively. Fifty-seven subjects (19.6%) had insufficient criteria for a diagnosis of inflammatory rheumatic disease despite positivity for both questionnaire and autoantibodies testing. During pregnancy, 18 patients required treatment with steroid and/or hydroxychloroquine to treat cutaneous and articular manifestations: 10 (16,1%) had UCTD e 8 (33,3%) had a major autoimmune rheumatic disease. Eleven patients received low dose aspirin and/or low molecular weight heparin as prophylaxis. Mean maternal age was higher in women with previously undiagnosed rheumatic diseases compared to healthy controls, while in this same group mean gestational age and birth weigh was lower. In multiple logistic regression, after adjustment for maternal age, the odds ratios of overall complications of pregnancy were 3.1 (95% confidence interval = 1.61 to 5.82) in subjects with UCTD and 5.74 (95% confidence interval = 2.3314.2) in those with definite diseases, respectively, compared to asymptomatic controls.
In our population approximately 2.5% and 1% of first trimester pregnant women had a previously undiagnosed UCTD and definite systemic rheumatic disease, respectively. These conditions are associated with significant negative effects on the outcome of pregnancy.
To cite this abstract, please use the following information:
Ramoni, Véronique, Caporali, Roberto, Spinillo, Arsenio, Beneventi, Fausta, Simonetta, Margherita, Locatelli, Elena, et al; Prevalence and Significance of Previously Undiagnosed Rheumatic Diseases in Pregnancy. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1954