Maternal and neonatal outcomes in pregnant women with autoimmune diseases in Pavia, Italy

Abstract

BackgroundThe increased number of childbearing women with autoimmune diseases leads to a growing interest in studying relationship among maternal disease, therapy, pregnancy and off-spring. The aim of this study was to determine the impact of autoimmune disease on pregnancy and on neonatal outcome, taking into account the maternal treatment and the transplacental autoantibodies passage.MethodsWe studied 70 infants born to 70 pregnant women with autoimmune disease attended in Fondazione IRCCS Policlinico San Matteo, Pavia, Italy from June 2005 to June 2012. Maternal and neonatal characteristics were collected and relevant clinical, laboratory, therapeutics, sonographic and electrocardiographic investigations were recorded and analyzed.ResultsWe observed a high rate of spontaneous abortions in medical history, 29 %, and 18.6 % of preterm births and 22.9 % of low birth weight (< 2500 g). Transplacental autoantibodies passage wasn’t related to maternal or obstetrical complication, but anti-Ro/SSA positive pregnancies correlated with abnormal fetal heart rate (P = 0.01). Pregnant women on therapy showed an higher incidence of maternal (p = 0.002), obstetric (p = 0.007) complications and an increased rate of intrauterine growth restriction (p = 0.01) than the untreated ones.ConclusionsAutoimmune diseases in pregnancy require to be carefully monitored to ensure the best possible management of mothers, fetuses and newborns due to the high rate of morbidity specially in case of maternal polytherapy and/or anti-Ro/SSA positivity.

Maternal autoimmune disease is not associated with cancer in the offspring

“…We then considered multiple sensitivity and secondary analyses. Both low and high birth weight have been associated with childhood cancer risk, 20,21 and mothers with an autoimmune disease are known to deliver smaller babies 22,23 . Thus, birth weight is potentially a mediator of the relationship between a maternal autoimmune disease and the offspring cancer risk.…”

Systemic erythematosus lupus and pregnancy outcomes in a Colombian cohort

“…6 However, with current knowledge on disease management and preconception counseling, these outcomes have improved, making more women eager to become pregnant regardless of their underlying medical condition. 7 During pregnancy, conditions that alter humoral immunity like SLE tend to have higher risks of flare-ups, negatively affecting maternal and fetal outcomes. 8,9 These adverse outcomes are associated not only with the disease activity throughout pregnancy but also with the disease activity at the time of conception.…”

Terapéutica fetal no invasiva

“…Una reciente revisión (18) destacó que la administración de immunomoduladores/inmunodepresores durante el embarazo ha demostrado ser relativamente segura, pero los resultados no son concluyentes. Por otra parte, no es ético realizar ensayos clínicos controlados en el embarazo.…”

“…De acuerdo con los autores citados, también esperamos que los registros internacionales de los potenciales efectos secundarios de medicamen-tos o de cualquier información útil relacionada con el embarazo y el resultado sobre el neonato se convierta en información común y de fácil acceso en los diferentes países. La administración de un cuestionario de cribado en el primer trimestre de la gestación ha demostrado ser una herramienta útil para identificar de antemano estos temas, para ser monitoreados cuidadosamente y, si es necesario, el tratamiento adecuado para proceder con éxito con el embarazo (18) .…”