Pregnancy outcomes in mixed connective tissue disease: a multicentre study

Abstract

Objectives In this study we aimed to investigate foetal and maternal pregnancy outcomes from a large multicentre cohort of women diagnosed with MCTD and anti-U1RNP antibodies. Methods This multicentre retrospective cohort study describes the outcomes of 203 pregnancies in 94 consecutive women ever pregnant who fulfilled the established criteria for MCTD with confirmed U1RNP positivity. Results The foetal outcomes in 203 pregnancies were as follows: 146 (71.9%) live births, 38 (18.7%) miscarriages (first trimester pregnancy loss of <12 weeks gestation), 18 (8.9%) stillbirths (pregnancy loss after 20 weeks gestation) and 11 (5.4%) cases with intrauterine growth restriction. Maternal pregnancy outcomes were as follows: 8 (3.9%) developed pre-eclampsia, 2 (0.9%) developed eclampsia, 31 (15.3%) developed gestational hypertension and 3 (1.5%) developed gestational diabetes. Women with MCTD and aPL and pulmonary or muscular involvement had worse foetal outcomes compared with those without. Moreover, we report a case of complete congenital heart block (0.45%) and a case of cutaneous neonatal lupus, both born to a mother with positive isolated anti-U1RNP and negative anti-Ro/SSA antibodies. Conclusion In our multicentre cohort, women with MCTD had a live birth rate of 72%. While the true frequency of heart block associated with anti-U1RNP remains to be determined, this study might raise the consideration of echocardiographic surveillance in this setting. Pregnancy counselling should be considered in women with MCTD.

Anti-U1RNP-70kD-positive case of neonatal lupus presenting with seizure and incomplete heart block: a case report and literature review

“…Only recently, CHB is being reported with anti-U1RNP with negative anti-Ro/SS-A and anti-La/SS-B (24). Similar to our case, a total of three patients who reported of having CHB with positive U1RNP (protein subtype not mentioned) and negative anti-Ro/SS-A and anti-La/SS-B but without any neurologic symptoms (24)(25)(26) were reported.…”

Antiphospholipid Antibodies in Inflammatory and Autoimmune Rheumatic and Musculoskeletal Diseases Beyond Lupus: A Systematic Review of the Available Evidence

“…In the MCTD cohort, Radin et al [22] documented around double the prevalence of Rai et al [23] taking into consideration that the subjects used in Radin et al's study were pregnant MCTD women. Notably, aPL-positive MCTD women had poorer fetal outcomes, which proposes whether MCTD pregnant patients should be regularly screened for aPL in order to receive higher doses of anticoagulation.…”

Immunology of pregnancy and reproductive health in autoimmune rheumatic diseases. Update from the 11th International Conference on Reproduction, Pregnancy and Rheumatic Diseases

“…In a more recent multicentre study on 203 pregnancies in MCTD, live birth rate was 72%. Women with MCTD and aPL and pulmonary or muscular involvement had worse fetal outcomes as compared with those without [120]. Cases of neonatal lupus have been reported in pregnant women with MCTD in absence of anti-Ro/SSA antibodies [119,120].…”