A Cohort Study of Pregnancy and Fetal Complications Among Patients with Rheumatologic Disorders

Abstract

Objective: We aim to investigate the maternal and fetal complications among women with rheumatic diseases (RDs) and evaluate the risk factors for adverse pregnancy outcomes.

Methods: In this cohort study, 241 women (comprising 401 pregnancies) who were diagnosed with RDs and sought treatment between 2016 and 2021 were evaluated and followed up for a duration of two years. Clinical backgrounds, pregnancy history, medication usage, immunological characteristics, and pregnancy outcomes were analyzed. Risk assessment for adverse outcomes in RDs was performed using binary logistic regression.

Results: The study revealed a 38.2% miscarriage rate and 56.9% live birth rate among 401 pregnancies. Maternal adverse events included gestational hypertension (4.7%), gestational diabetes mellitus (2.7%), and (pre)eclampsia (1.7%). Fetal adverse outcomes consisted of miscarriages in 153 (38.2%), low birth weight in 45 (11.2%), preterm labor in 20 (5%), and fetal heart block in eight (2%). Risk factors associated with adverse fetal outcomes were systemic lupus erythematosus (SLE) (OR 8.24, 95% CI 1.65-41.15), vasculitis (OR 8.06, 95% CI 2.7-24.02), SLE/Sjögren's syndrome (SS) overlap (OR 4.05, 95% CI 1.8-9.11), and history of hypothyroidism (OR 2.81, 95% CI 1.52-5.2).

Conclusion: RDs exerted a negative impact on pregnancy outcomes, resulting in complications for both the mother and the fetus. Our study emphasizes the significance of effectively managing RDs during pregnancy, with particular emphasis on SLE, vasculitis, and the overlap of SS with SLE. To improve pregnancy outcomes, a multidisciplinary approach, early identification of high-risk patients, and the implementation of individualized treatment plans are recommended.

Keywords: Maternal; Neonatal; Pregnancy; Pregnancy outcome; Rheumatic disease; Rheumatoid arthritis; Systemic lupus erythematous.