Ab0681 history of abortion and multiparity in systemic autoimmune diseases: results from a multidisciplinary pregnancy clinic (gynecology, rheumatology and nephrology)

Background Pre-conception counselling and risk stratification performed in a multidisciplinary clinical setting with rheumatologists, obstetricians and nephrologists may improve pregnancy outcomes in systemic autoimmune disease (SAD). Objectives To compare clinical, obstetrical comorbidities and pregnancy outcomes in patients with SAD with history of pregnancy loss with patients without history of pregnancy loss. Methods A retrospective cohort study was conducted. A total of 41 patients with SADs that attended the multidisciplinary preconception outpatient clinic were included. Variables related to SADs, obstetric comorbidities and pregnancy outcomes were collected. Description of the sample and comparison of groups were carried out. Shapiro-Wilk test was used to study normality. Results The description and comparison of the comorbidities, preconception counselling and pregnancy outcomes are summarized in Table 1. A total of 18 (46%) patients had a history of pregnancy loss. Fewer patients with history of pregnancy loss, 38.5% were fit for conception compared to 54.3% of patients with a history of pregnancy loss. Deferment of pregnancy was advised for 38.5% of patients with history of pregnancy loss and 54.3% in patients without history of pregnancy loss. Patients with a history of pregnancy loss had significantly higher anti-DNAds, antiphospholipid positivity and longer time since last flare.There was no significant difference for adverse pregnancy outcomes, disease activity or treatment. Interestingly, the distribution of risk profile for adverse pregnancy was different between both groups: there were more moderate and high risk for adverse pregnancy in patients with a history of pregnancy loss. Conclusion Patients with a history of pregnancy loss present delay to plan a new pregnancy, higher anti-DNA and antiphospholipid positivity. No worse pregnancy outcomes were observed. Table 1. Patients with previous abortion (n=13) Patients without previous abortions (n=28) P value Sociodemographic data Age at visit (year) 36.8±4.61 34.4±3.93 0.43 Age at diagnosis (year) 28.31±2.48 28.617±1.35 0.9 Diagnosis-1 st visit (years) 8±6.71 6.93±5.5 0.58 Last flare-1 st visit (months) 47±39.45 27±38.59 0.049 Immunological data Anti-DNAds 61.17±52.46 42.62±52.46 0.043 LA, n (%) 11 (84.6) 5 (17.9) 0.004 Anti-cardiolipin, n (%) 9 (69.2) 5 (17.9) 0.003 Ro52, n (%) 3 (23.1) 4 (14.3) 0.49 Ro60, n (%) 1 (7.7) 4 (14.3) 0.55 Diagnosis, n (%): -SLE 6 (46.2) 13 (46.4) 0.99 -APS 1 (7.5) 1 (3.57) 0.58 -Autoinflammatory 0 3 (10.71) 0.39 -Other 6 (46.2) 11 (39.3) 0.68 Before preconception counselling 0.39 Treatment, n (% ) -c/tsDMARD 4 (30.8) 7 (25) -HCQ 3 (23.1) 5 (7.9) - bDMARDs 2 (15.4) 9 (32) GC (n, % ) 7 (53.9) 14 (49.9) 0.82 CYC (n, % ) 2 (15.4) 3 (10.7) 0.67 After preconception counselling 0.24 Complications in pregnancy (n,%): -Medical 2 (15.4) 0 -Obstetrical 0 3 (10.7) Fertility assistance (n, % ) 0.73 -Assisted Non-assisted 0 11 (100) 1 (8.3) 11 (91.7) Abortion (n, % ) 1 (7.69) 0 0.44 Disclosure of Interests None declared