Two new studies reinforce the importance of more intensive monitoring during and after pregnancy for women with rheumatic diseases.
The maternal and neonatal outcomes of women with Sjogren’s syndrome are so poor that researchers are calling for women with the autoimmune disease to have pre-pregnancy counselling.
The Taiwanese database study, published in Rheumatology, investigated the pregnancy outcomes of 449 women with Sjogren’s over an 11-year period and compared them with almost 2 million non-Sjogren’s controls.
Researchers found that the babies born to Sjogren’s patients had a significantly lower average birth weight and were more likely to be born preterm. Common adverse fetal outcomes also included neonatal lupus and congenital heart block.
Dr Abhishikta Dey, a Sydney-based early career rheumatologist with a special interest in obstetrics, said the study was a reminder that people with Sjogren’s syndrome need to have more intensive monitoring and prenatal counselling.
“This shows me that yes, there’s some indicator that the mums and bubs don’t do as well. However, we definitely need more information that’s collected in a prospective, systematic way with lab details so that we can try and work out which patients are most at risk,” she told Rheumatology Republic.
“I want to provide education, but I also want people not to get too scared and anxious about having a child when it should be the most exciting part of your life.”
The researchers also reported a higher risk of preeclampsia after adjusting for maternal age, but this risk did not remain significant after adjusting for additional confounders.
“Our findings highlight the need for preconception counselling in women with [Sjogren’s syndrome] to control the disease,” the researchers wrote, noting also that increased monitoring during pregnancy may benefit women with Sjogren’s syndrome.
Meanwhile, another recent study on rheumatic disease in pregnancy, published in Arthritis Care & Research, recommended women with rheumatoid arthritis or systemic lupus erythematosus be monitored closely for up to a year following delivery.
The population-based retrospective cohort study captured data from roughly 1200 women with RA and 1400 with SLE, as well as a control group, who gave birth in the US state of Washington between 1987 and 2014.
The women with rheumatic diseases were more likely than their peers to have preeclampsia and go into premature labour.
Their babies, meanwhile, were more likely than control group infants to be small for gestational age, be born preterm and to spend time in the neonatal intensive care unit.
This effect held despite the fact that women with RA and SLE tended to receive more intensive prenatal care than their peers.
Around 12% of women with RA and 16% of women with lupus were rehospitalised following delivery, along with a similar proportion of their infants.
“Reasons for rehospitalisation varied, with musculoskeletal conditions exhibiting the greatest risk of maternal rehospitalisation,” the study authors said.
“It is possible that a flare of disease contributed to these findings.”
The researchers reasoned that it was likely that any skin, respiratory and genitourinary-related hospitalisations among the rheumatic group could be related to maternal immunosuppression and resultant infection but called for further research to better capture those reasons.
Dr Dey agreed that it would be useful to have a deeper understanding of the reasons for readmission and said the evidence that women with rheumatic diseases were at higher risk of readmission was valuable in itself.
“It does reaffirm that, obviously women can be really busy postpartum … [and] feel like it may be an inconvenience for them to come and see me when they have a four-week-old child. But they should come anyway, it should be a priority,” she said.
“We want to make sure that they’re not flaring postpartum and try to mitigate any rehospitalisations.”
