The study: Harding CC, Eudy AM, Sims CA, et al. The impact of pregnancy readiness on lupus activity, maternal mental health & pregnancy outcomes. Arthritis Care Res (Hoboken). 2024 Sep 8. Online ahead of print.
Pregnancy Outcomes from a Multidisciplinary Obstetric-Medicine/Rheumatology Clinic
A 5-year retrospective analysis
By Griffin Reed, MD, & Joanne S. Cunha, MD
Why was this study done? Rheumatic illnesses frequently affect women of childbearing age and treatment decisions affect the patient’s health, fertility and pregnancy outcomes. Multi-disciplinary clinics combining obstetric-medicine internists and rheumatologists are scarce, with only four known programs of this kind in the U.S.
What were the study methods? We performed a five-year retrospective chart review of patients seen in our combined obstetric-medicine/rheumatology clinic, from Jan. 1, 2016, through Dec. 31, 2021. Comprehensive demographic data on medication exposures and pregnancy outcomes were collected into an electronic database to characterize the mother’s rheumatologic diagnosis and identify comorbidities, medications and pregnancy outcomes.
What were the key findings? Eighty-one patients were seen at this clinic, and 61 were pregnant during at least one visit. The most common rheumatologic diagnoses were systemic lupus erythematosus (SLE), at 22%, and rheumatoid arthritis (RA), at 12%.
Details on the medications initiated, changed or discontinued in 87 patient visits (preconception, prenatal and postpartum encounters) can be found in Table 2 of the article. Fifty-four percent of patients received conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) and 17% received biologic DMARDs.
Low-dose aspirin was given in the antepartum period or during pregnancy in 28% of patients.
What were the main conclusions? Hydroxychloroquine, prednisone and certolizumab pegol were the most commonly prescribed medications during the preconception or pregnancy periods, which underscores the safety and efficacy of these medications during pregnancy.
Aspirin prophylaxis is recommended for patients with high-risk pregnancies, including those with SLE or antiphospholipid syndrome. Of pregnancies in our patients, 8% were complicated by preeclampsia, compared with 4% of the general U.S. population. This confirmed the higher rate of preeclampsia seen in patients with systemic autoimmune diseases and supports the need for aspirin prophylaxis in this patient population.
What are the implications for patients & clinicians? This study illustrates the advantages of a combined obstetric-medicine and rheumatology clinic in managing patients with rheumatologic disorders during the prenatal and perinatal periods. This multi-disciplinary approach allows for complex treatment decisions to be made with the goal of optimizing rheumatologic disease control as well as maternal and fetal outcomes.
