Vigilance needed for rare autoimmune disease pregnancies

Pregnant women with rare autoimmune diseases have an increased risk of maternal and neonatal complications yet many are not managed in specialist centres, Australian researchers report.

The analysis of 409 births to 293 women with rare autoimmune diseases found that while the majority of births were in urban hospitals just over half of the births took place in tertiary referral centres.

“Given that more obstetric and neonatal interventions are required for this group of women and their babies it would seem prudent to recommend that deliveries are conducted where more specialist services are available,” wrote the authors including Professor Lyn March and Professor Christine Roberts from the Institute of Bone and Joint Research at the Kolling Institute.

Compared to the general population women with rare autoimmune diseases – defined as systemic vasculitis, vasculitis, Sjorgren’s syndrome, systemic sclerosis, Behcet’s disease, dermatopolymyositis – had higher rates of hypertensive disorders, antepartum haemorrhage, severe maternal morbidity and required longer hospital stays after delivery.

Infants born to mothers with autoimmune disease were at an increased risk of admission to neonatal intensive care, severe neonatal morbidity and perinatal death.

Pregnancy in rate autoimmune diseases requires close co-operation between women and their healthcare providers, the researchers said.

They advised that women should be counseled pre-pregnancy about risk of pregnancy loss, maternal morbidity and neonatal morbidity and mortality.

“Vigilant surveillance by a multidisciplinary team throughout the perinatal period is warranted for these women and their infants”, they concluded in their paper published in Arthritis & Rheumatology.

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