For women with RA, patient-reported measures of disease activity may be useful adjuncts to physician-reported measures in identifying pregnancies at greater risk. In contrast, in SLE, no patient-reported measures were associated with adverse outcomes while physician measures of disease activity helped predict several adverse pregnancy outcomes. This article is protected by copyright. All rights reserved.
Objective Systemic lupus erythematosus (SLE) patients have more pregnancy complications than healthy patients. Data regarding pregnancy outcomes in women with undifferentiated connective tissue disease (UCTD) are more limited, and existing studies are concentrated in Italy and predominantly in patients with a new diagnosis. Our objective was to compare pregnancy outcomes for UCTD and SLE patients with established disease. Methods Between 2008 and 2017, patients with UCTD and SLE at an academic medical center were recruited to a prospective pregnancy registry. UCTD was defined as a positive autoantibody plus connective tissue disease symptoms not meeting criteria for another rheumatic diagnosis. SLE was defined by American College of Rheumatology or Systemic Lupus International Collaborating Clinics classification criteria or by physician diagnosis. Data were collected throughout pregnancy and postpartum. Comparator groups included UCTD, low‐activity SLE, and high‐activity SLE. Results A total of 150 SLE and 51 UCTD pregnancies were analyzed. Disease activity was low in most patients, although more patients with SLE had severe activity during pregnancy (12% versus 2%; P = 0.05). The frequencies of prematurity and preeclampsia were significantly lower in UCTD than in high‐activity SLE patients (preterm 17% versus 45% [P = 0.004] and preeclampsia 6% versus 34% [P = 0.0008]), although similar to low‐activity SLE patients. More infants who were small for gestational age were born to SLE than UCTD patients (33% versus 7% [P = 0.0005]), regardless of disease activity level. Conclusion Pregnancies in women with UCTD managed by a rheumatologist have a high rate of pregnancy success and fewer risks than those in women with active SLE.
The effects of l-thyroxine and of surgical thyroidectomy upon the survival of blastocysts have been studied in 200 albino rats. These rats were ovariectomized on the 3rd day of pregnancy, and maintained on progesterone in order to delay implantation. Delay of implantation was confirmed by laparotomy on the 8th day of pregnancy. Subsequent implantation was accomplished by giving 1 \ g=m\ g oestrone daily from the 9th day of pregnancy. At autopsy on the 14th day of pregnancy hyperthyroid rats and hypothyroid rats which had been maintained on daily injections of 2\m=.\0 mg progesterone did not differ from their respective control groups in the number of surviving blastocysts. However, hyperthyroid rats which had been maintained on daily injections of 0\m=.\4mg progesterone possessed more implantation sites than controls. Similarly, the hypothyroid rats maintained on daily injections of 0\m=.\3 mg progesterone had fewer implantation sites than controls. The experiments suggest that the level of hyperthyroidism tested is beneficial to the maintenance of implantation of delayed blastocysts when low amounts of progesterone are available, while hypothyroidism tends to be detrimental to this process during low progesterone availability.
Using the technique of delayed implantation of blastocysts in the rat, hyperthyroidism counteracts the effects of progesterone deficiency upon blastocyst survival and implantation while hypothyroidism contributes to the severity of the progesterone deficiency. In non-pregnant rats, treated in a manner to duplicate the delayed implantation experiments, the localization pattern of alkaline phosphatase within the uterine endometrium closely corresponds with the fate of the blastocysts. Hyperthyroidism during progesterone deficiency restores to normal the distribution of uterine alkaline phosphatase while hypothyroidism is associated with a further depletion of uterine alkaline phosphatase. Oxygen consumption studies indicate that the changes in the alkaline phosphatase are not associated with changes in the general uterine metabolism.
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