•Anti-Ro/SS-A and anti-La/SS-B are clinically very relevant during pregnancy mainly because of their association to congenital heart block and neonatal lupus. •In our cohort, the prevalence of congenital heart block detected in patients taking hydroxycloroquine is much lower than in patients not taking it without distinguishing between high and low risk patients. •High umbilical artery pulsatility index in Doppler scans studies has been detected in our anti-Ro/SSA population (basely in SLE patients) demonstrated this measurement as a predictor of SGA and adverse pregnancy outcomes in general population such as cesarean section for fetal distress. The small for gestational age rate is higher probably because of SLE not because anti-Ro/SS-A •Preterm delivery happens in anti-Ro/SS-A patients at the same rate as in the general population if no complications such as congenital heart block or intrauterine growth restriction occur.
BackgroundAutoimmune diseases predominantly affect women of childbearing age. These women must be without clinical activity before conception, which is usually achieved thanks to immunosuppressive drugs. Also, information on new drugs does not include their possible effects on pregnancy because pregnant women are usually excluded from clinical trials.ObjectivesThe aim of the study is to evaluate the safety of biological drugs (BD) in pregnant patients with different autoimmune diseases (AD).MethodsPatients were prospectively followed in a reference Spanish center for high-risk pregnancies and AD. Follow-up was performed by a multidisciplinary team with at least one obstetrician and one expert clinician in autoimmune diseases. Females exposed to BD during the periconceptional period or during pregnancy were included in the study. Obstetric and neonatal outcomes were assessed.ResultsBetween 2015 and 2018 we identified 37 exposed pregnancies in 35 women affected by different AD. At the start of pregnancy, 18 patients were taking infliximab, 11 adalimumab, 3 natalizumab, 2 rituximab, 1 etanercept y 1 tocilizumab.The AD that required BD were Crohn’s disease (20 patients, 54.1%), ulcerative colitis (7, 18.9%), rheumatoid arthritis (4, 10.8%), ankylosing spondylitis (3, 8.1%) and multiple sclerosis (3, 8.1%).Regarding pregnancies, 5 (13.5%) had left the BD just before the pregnancy. Of these, 1 remained stable and 4 (80%) had a flare during pregnancy requiring restart of BD. Of the 32 pregnancies who took the BD during pregnancy, 8 (25%) abandoned the treatment after knowing the pregnancy, meaning that 2 of them flared; 10 (31.5%) continued with the treatment until the end of the second trimester (week 25-26) and 14 (43.7%) continued during the third trimester, 4 of them kept the drug during the entire gestation due to disease activityIn our study there was a positive correlation between preconceptional abandonment of the BD and the risk of presenting a flare (p=0.003), specially in the first and second trimesters (p=0.024). However, no relationship was found between BD and infections in the newborn (p>0.05), nor between each of the BD with the risk of infections.Preconceptional treatment reduced the risk of flare (OR 0.545, 95%CI) and the risk of maternal complications (OR 0.5, 95%CI). Indeed, the presence of a flare during pregnancy increased the risk of maternal complications (OR 2.0, 95%CI).Pregnancies under BD were compared to healthy controls adjusted by age finding no differences in the preterm delivery rate (p>0.05), in the induction rate of delivery (p>0.05) nor in the cesarean section rate (p>0.05).ConclusionIn our series, the use of preconceptional BD and/or during pregnancy is not associated with an increase of maternal or fetal complications. However, fewer flares were observed. This may imply that BD can be a good tool for the treatment of women of childbearing age since control of the disease resulted in better maternal-fetal outcomes. However, more studies are needed to determine the usefulness and safety...
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