Ab0630 pregnancy in autoimmune diseases: the impact of pregnancy planning on reproductive outcomes in a multidisciplinary preconception outpatient clinic

Background Pregnancy in patients with systemic autoimmune diseases (SADs) are known to be at high risk for the occurrence of adverse pregnancy outcomes. Pre-conception counselling and risk stratification performed in a multidisciplinary clinical setting are essential for improving pregnancy outcomes and reducing maternal and perinatal complications in patients with SADs. Objectives To describe clinical, obstetric and maternal comorbidities and pregnancy outcomes in patients with SADs. Methods A retrospective cohort study was conducted. Inclusion criteria were patients diagnosed with SADs that were examined by the multidisciplinary pregnancy clinic. Clinical, maternal and obstetric variables were collected. The multidisciplinary team evaluated if the risk of pregnancy was high, moderate or low. Data related to pregnancy outcomes were also collected. Mean, standard deviation and proportions were calculated. Results A total of 41 patients interested in getting pregnancy attended our outpatient preconception clinic, with a mean age at first visit of 35.7±4.43 years. The ethnicity of the patients was: 75.6% Caucasian, 19.5% Hispanic and 4.9% Asian. Sociodemographic, clinical, treatment data, maternal and obstetric comorbidities are summarized in Table 1. Prior to preconception counselling, history of live births occurred in 61%, pregnancy loss in 32%, preterm birth in 10.5% and low-weight at birth in 11.7% of patients. 53.66% of patients were under treatment with c/tsDMARDs and/or bDMARDs and 19.5% with hydroxychloroquine. As much as 43.9% were taking ≤7.5 mg of prednisolone/day and 7.3% were taking >7.5 mg/day. After evaluation by the multidisciplinary pregnancy clinic, 51.2% of patients were classified as low risk, 39% as moderate and 9.8% as high risk for adverse pregnancy outcomes. The final assessment was conception without treatment changes for 46.3% of the patients, treatment changes before conception for 12.2%, postponement of pregnancy for 24.4% and 17% of patients were pregnant at their first visit. Of these women, 15 conceived (36.6%) after a median time of 6.25±4.5 months. Medical and obstetric complications occurred in 13% and 20% of the patients. Abortion occurred in 9.76%, preterm birth in 4.88% and low-weight at birth in 11.1% of patients. Conclusion 46% of patients attending our pregnancy outpatient clinic had a diagnosis of SLE. Out of the 41 patients assessed, 59% were advised to conceive and 12% were discouraged. 36.6% of patients were able to get pregnant, with a reduction in maternal and perinatal complications after preconception counselling. Well-planned pregnancies, adequate treatment and pre-conception evaluation will contribute to an improved outcome, both for the mother and the child. Table 1. Total (n=41) Sociodemographic data Age at visit, mean±SD Age at diagnosis, mean±SD 35.7±4.43 28.5±7.65 Diagnosis, n (%): - SLE - APS - Other CTDs - Inflammatory arthritis - Autoinflammatory 19 (46.34%) 2 (4.88%) 15 (36.59%) 2 (4.88%) 3 (7.32%) Before preconception counselling Median nº of pregnancies, n (% )- 0 - 1 - 2 - 3 16 (39%) 16 (39%) 7 (17%) 2 (4.9%) Abortion, n (% )- 0 - 1 - 2 Preterm, n (% ) Low-weight at birth, n(% ) 21 (61.8%) 10 (29.4%) 3 (8.8%) 2 (4.88%) 2 (11.7%) Treatment, n (%)- c/tsDMARD - HCQ - bDMARDs - None 11 (26.83%) 8 (19.5%) 11 (26.83%) 11 (26.83%) Glucocorticoid dose, n (%)- <7.5 mg/day - >7.5 mg/day Previous Cyclophosphamide, n (% ) 18 (43.9%) 3 (7.3%) 5 (12.2%) Multidisciplinary team evaluation: Pregnancy risk, n (%)- Low - Moderate - High 21 (51.2%) 16 (39.02%) 4 (9.76%) Assessment, n (%): - Fit to conception - Not fit to conception - Fit with medication change - Pregnant at first visit 19 (46.34%) 10 (24.4%) 5 (12.2%) 7 (17.07%) After preconception counselling Fertility assistance, n (% )- Assisted - Non-assisted Abortion Low-weight at birth Preterm birth 2 (13.3%) 13 (86.7%) 4 (9.76%) 1 (11.1%) 2 (4.88%) Treatment - c/tsDMARDs - bDMARDs - HCQ - None 12 (29.3%) 6 (14.6%) 10 (24.4%) 13 (31.7%) Glucocorticoid dose - <7.5 mg/day - None 19 (46.3%) 22 (53.7%) REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.