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Background: Pregnancy is a topic of fundamental importance for women living with autoimmune rheumatic diseases (ARD). Efforts at national and international levels have been put in the collection and harmonization of data in order to implement an evidence-based management of pregnant patients.
Objectives: The P-RHEUM.it study was designed as a nationwide, web-based longitudinal observational cohort study to collect data about pregnancy in ARD in 26 centers in Italy. The study started in May 2018 and has been supported by the Italian Society for Rheumatology.
Methods: Pregnant patients with a definite rheumatic disease according international criteria were enrolled up to gestational week (GW) 20. The course of maternal disease activity, the use of medications, fetal and maternal complications, and the quality of life (EuroQoL questionnaire) were collected for each trimester, as well as pregnancy outcome, mode of delivery, neonatal complications, and maternal and children’s follow-up to 6 months after delivery, including the screening for post-partum depression by means of EPDS (Edinburgh Postnatal Depression Scale).
Results: As of December 2021, 758 pregnancies had been enrolled, 205 (27%) ongoing and 553 (73%) with outcome. Pregnancy loss occurred in 54 (9.8%) cases (40 spontaneous miscarriages; 6 voluntary terminations). Live births were 495 (89.5%), perinatal death occurred in 4 (0.7%) cases.
| PREGNANCIES WITH LIVE BIRTHS, EXCLUDING PERINATAL DEATHS | Total pregnancies (n=495) | RA pregnancies (n=69) | SLE pregnancies (n=93) |
|---|---|---|---|
| Age at conception (years) | 34 (31 - 37) | 34.5 (32 - 38) | 34 (31 - 36) |
| Disease duration (years) | 6.1 (2.2 - 11.1) | 7.1 (4.3 - 11.6) | 9.3 (5.9 - 15.9) |
| Caucasian | 431 (87.8%) | 53 (79.1%) | 75 (80.6%) |
| Never smokers | 358 (73.8%) | 53 (80.3%) | 66 (71.7%) |
| Body Mass Index >30 | 45 (9.5%) | 7 (10.3%) | 5 (5.6%) |
| Arterial Hypertension | 6 (1.2%) | 0 (0%) | 2 (2.2%) |
| Time to pregnancy (months) | 3 (1 - 6) | 3 (1 - 6) | 3 (0 - 10) |
| Physician-reported flares in the 12 months prior to conception | 107 (23%) | 22 (34.4%) | 13 (14.8%) |
| Physician global assessment at enrolment (VAS 0-100) | 5 (0 - 17) | 5 (0 - 20) | 4 (0 - 10) |
| Patient global health at enrolment (VAS 0-100) | 18 (7 - 30) | 10 (5 - 29) | 10 (5 - 25) |
| EuroQoL at enrolment (-1.6 – 1) | 1 (0.8 - 1) | 1 (0.8 - 1) | 1 (0.8 - 1) |
| Flares during pregnancy | 35 (7.1%) | 6 (8.7%) | 7 (7.5%) |
| Hypertensive disturbances* | 8 (1.7%) | 1 (1.6%) | 6 (6.6%) |
| Delivery at term (≥37 GW) | 410 (85.1%) | 53 (77.9%) | 74 (80.4%) |
| Spontaneous vaginal delivery | 173 (35.9%) | 23 (33.8%) | 23 (25.3%) |
| Congenital malformations | 11 (2.4%) | 2 (3.1%) | 1 (1.1%) |
| Small for gestational age (SGA) neonate | 24 (4.9%) | 1 (1.4%) | 9 (9.9%) |
| Breastfeeding in the first 4 weeks after delivery | 341 (79.7%) | 45 (77.6%) | 59 (76.6%) |
| EPDS score at risk for post-partum depression | 22 (14.1%) | 0 (0%) | 3 (10.3%) |
Continuous variables are expressed as median (interquartile range); *gestational hypertension/preeclampsia/HELLP syndrome/eclampsia.
Conclusion: Multiple factors may have contributed to the high rate of live births, including good disease control before and during pregnancy thanks to the use of anti-rheumatic drugs and low frequency of general risk factors. SLE pregnancy was affected by a higher frequency of complications (hypertensive disturbances, SGA babies) as compared to RA pregnancy. Nearly 80% of patients breastfed in the first month after delivery. For the first time, data about the screening questionnaire for post-partum depression were collected, showing at least 1 out 10 patients can be at risk.
REFERENCES:
[1]Meissner Y et al. Arthritis Res Ther;21(1):241; Ann Rheum Dis. 2021;80(1):49-56.
Acknowledgements: P-RHEUM.it study is supported by the Italian Society for Rheumatology (SIR). All the Investigators are acknowledged for their contribution.
Disclosure of Interests: None declared