A multicentre study of 244 pregnancies in undifferentiated connective tissue disease: maternal/fetal outcomes and disease evolution

Abstract

Objectives To investigate fetal/perinatal and maternal outcomes from a large multicentre cohort of women diagnosed with UCTD. Methods This multicentre retrospective cohort study describes the outcomes of 224 pregnancies in 133 consecutive women with a diagnosis of UCTD, positive for ANA and aged <45 years old at study inclusion. Results Of the 224 pregnancies analysed, 177 (79%) resulted in live births, 45 (20.1%) in miscarriages (defined as pregnancy loss before 12 weeks’ gestation), 2 (0.9%) in stillbirths (pregnancy loss after 20 weeks’ gestation) and 6 (2.7%) cases showed intrauterine growth restriction. Miscarriages and stillbirths were strongly associated with the presence of aPL and ENA antibodies (P < 0.05). Maternal pregnancy complications were as follows: 5 (2.2%) cases developed pre-eclampsia, 11 (4.9%) cases gestational hypertension and 12 (5.4%) cases gestational diabetes. Joint involvement represented the most frequent clinical manifestation of the cohort (57.9%), followed by RP (40.6%), photosensitivity (32.3%) and haematological manifestations (27.1%). The rate of disease evolution of our cohort from a diagnosis of UCTD to a diagnosis of definite CTD was 12% within a mean time of 5.3 ± 2.8 years. With a total follow-up after first pregnancy of 1417 patient-years, we observed the evolution to a defined CTD in one out of every 88 patient- years. Conclusion In our multicentre cohort, women with UCTD had a live birth rate of 79%. Women with UCTD should be referred to specialist follow-up when planning a pregnancy. ENA profiling and aPL testing should be mandatory in this setting, and further therapeutic approaches and management should be planned accordingly.

Impact of the 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus in a Multicenter Cohort Study of 133 Women With Undifferentiated Connective Tissue Disease

“…The multicenter retrospective study (8)described the foetal/perinatal and maternal outcomes of a cohort of UCTD patients ever pregnantfrom 2010 to 2019.…”

“…All rights reserved All patients were diagnosed with UCTD according to the established consensus (4,9,10)and were ANA positive. ANA positivity was confirmed and tested as previously described (8).…”

“…Clinical and laboratory characteristics of the cohort have been previously described elsewhere (8).Briefly, the most common clinical manifestations were joint involvement (57.9%), followed by Raynaud's phenomenon (40.6%), photosensitivity (32.3%) and haematological manifestations (27.1%). Thirty-three patients (24.8%) tested persistently positive for aPL (13)andforty-eight patients (36.1%) were also found to be positive for anti-ENA, being anti-Ro/SSA positivity the most common (45 patients; 33.8%).…”

A three-arm, multicenter, open-label randomized controlled trial of hydroxychloroquine and low-dose prednisone to treat recurrent pregnancy loss in women with undifferentiated connective tissue diseases: protocol for the Immunosuppressant regimens for LIving FEtuses (ILIFE) trial

“…Therefore, it could increase uterine artery resistance, inhibit placenta development and remodeling, and thus increase the risk of preeclampsia, intrauterine growth retardation (IUGR), small for gestational age infant (SGA), and recurrent spontaneous abortion (RSA) [ 3 , 11 – 14 ]. A multicenter retrospective cohort study showed that 21% of pregnancy resulted in miscarriages or stillbirths [ 15 ]. Spinillo found that women with UCTD had a higher rate (39.0%) of at least 1 spontaneous pregnancy loss than healthy controls with an odds ratio of 5.92 (95% CI, 2.1–17.8) [ 14 ].…”

A three-arm, multicenter, open-label randomized controlled trial of hydroxychloroquine and low-dose prednisone to treat recurrent pregnancy loss in women with undifferentiated connective tissue diseases: Protocol for the immunosuppressant regimens for Living FEtuses (ILIFE) Trial

“…Therefore, it could increase uterine artery resistance, inhibit placenta development and remodelling, and thus increase the risk of pre-eclampsia, intrauterine growth retardation (IUGR), small for gestational age infant (SGA) and recurrent spontaneous abortion (RSA) [3,[11][12][13][14]. A multicentre retrospective cohort study showed that 21% of pregnancy resulted in miscarriages or stillbirths [15]. Spinillo found that women with UCTD had a higher rate (39.0%) of at least 1 spontaneous pregnancy loss than healthy controls with an odds ratio of 5.92 (95% CI, 2.1-17.8) [14].…”