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Outcomes de Gravidez em Doenças Reumáticas Inflamatórias: Casuística do Serviço de Reumatologia
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Abstract(s)
Introdução: A gravidez em mulheres com doenças reumáticas está associada a um risco
acrescido de resultados adversos maternos e fetais. No entanto, evidências atuais indicam
que, com um planeamento adequado, é possível alcançar gravidezes bem-sucedidas.
Objetivos: Avaliar o impacto das doenças reumáticas inflamatórias nas gravidezes das
utentes acompanhadas pelo serviço de reumatologia da ULS da Guarda nos últimos 15 anos.
Materiais e Métodos: Estudo transversal, observacional e descritivo, baseado na recolha
de dados clínicos do sistema SClínico de utentes seguidas pelo serviço de reumatologia da
ULS da Guarda, que engravidaram após diagnóstico de doença reumática inflamatória.
Critérios de inclusão: Mulheres em idade fértil com diagnóstico de doença reumática
inflamatória (artrite reumatóide, espondiloartrite, artrite psoriática, lúpus eritematoso
sistémico, síndrome antifosfolípido, síndrome de Sjögren, doença mista do tecido
conjuntivo ou doença indiferenciada do tecido conjuntivo) e história de gravidez.
Critérios de exclusão: Mulheres com outras condições reumáticas não listadas, gravidezes
anteriores ao diagnóstico ou ausência de consentimento informado.
Os registos clínicos foram analisados após o cruzamento de dados entre as consultas ou
internamentos dos serviços de reumatologia e obstetrícia.
Resultados: Vinte e quatro mulheres preencheram os critérios de inclusão, totalizando 31
gravidezes. A média de idade atual foi de 39,3±3,5 anos; a média de idade ao diagnóstico foi
de 29,4±6,2 anos e ao parto, de 34,3±4,2 anos. Entre estas mulheres, 41,7% tinham artrite
reumatóide, 16,7% espondiloartrite axial, 12,5% espondiloartrite com doença inflamatória
intestinal ou síndrome de Sjögren e 4,2% tinham artrite psoriática, lúpus eritematoso
sistémico ou outras doenças do tecido conjuntivo.
Durante a gravidez, 71% das utentes não apresentaram comorbilidades. A doença
encontrava-se ativa (utilizando as pontuações de atividade específicas para cada doença)
em 16,1% das mulheres no momento da conceção; 9,7% registaram atividade durante a
gravidez, enquanto as restantes se mantiveram estáveis ou melhoraram. A exacerbação pósparto foi observada em 25,8%.
A gravidez foi planeada em 87,1% dos casos, sendo que 35,5% receberam aconselhamento
pré-concecional; e 3,2% das gravidezes ocorreram através de tratamento de fertilidade. Registaram-se quatro abortos espontâneos e 28 nados-vivos, incluindo uma gravidez
gemelar. Os métodos de parto incluíram 55,6% cesarianas, 37% partos vaginais e 7,4%
partos assistidos. Nascimentos prematuros ocorreram em 3,2% dos casos, tal como casos
de sofrimento fetal. Os resultados fetais saudáveis representaram 87,1%, com 9,7% de baixo
peso à nascença e nenhum caso de lúpus neonatal, apesar de 16,1% das mães serem positivas
para o anticorpo anti-SSA.
Quanto à utilização de medicamentos modificadores de doença reumática (DMARDs),
25,8% das utentes não estavam medicadas com DMARDs no período pré-gestacional. Entre
as que estavam medicadas, identificámos 22,6% sob hidroxicloroquina e 19,5% sob
prednisolona. Com a mesma frequência, encontrámos sulfassalazina e metotrexato, sendo
outros medicamentos utilizados em percentagens mais baixas. Durante a gravidez, 54,8%
interromperam o uso de DMARDs e 45,2% continuaram o tratamento.
Conclusões: Apesar dos desafios colocados pelas doenças reumáticas, o acompanhamento
em reumatologia permitiu que a maioria das mulheres tivesse uma gravidez bem-sucedida,
o que resultou no nascimento de 28 crianças sob os cuidados do serviço de reumatologia da
ULS da Guarda nos últimos 15 anos.
Introduction: Pregnancy in women with rheumatic diseases carries an increased risk of adverse maternal and fetal outcomes. However, real-world data indicate that, with proper planning, successful pregnancies are achievable. Objectives: To evaluate the impact of inflammatory rheumatic diseases on the pregnancies of patients followed by the Rheumatology Department of ULSG over the past 15 years. Materials and Methods: A cross-sectional, observational, descriptive study collected clinical data from the SClínico system for patients in the Rheumatology Department of ULSG who became pregnant post-diagnosis. Inclusion criteria: Women of childbearing age with a diagnosis of inflammatory rheumatic disease (rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, Sjögren’s syndrome, mixed connective tissue disease, or undifferentiated connective tissue disease) and a history of pregnancy. Exclusion criteria: Women with other rheumatic conditions not listed, pregnancies before diagnosis, or lack of consent. Clinical records were reviewed, cross-referencing rheumatology and obstetric appointments or admissions. Results: Twenty-four women met inclusion criteria, encompassing 31 pregnancies. The mean current age was 39.3±3.5 years; age at diagnosis was 29.4±6.2 years, and at delivery, 34.3±4.2 years. Among these women, 41,7% had rheumatoid arthritis, 16,7% axial spondyloarthritis, 12,5% spondyloarthritis with inflammatory bowel disease or Sjögren’s syndrome, and 4,2% had psoriatic arthritis, lupus, or other connective tissue diseases. During pregnancy, 71% had no comorbidities. The disease was active (using activity scores for each disease) in 16.1% at conception; 9.7% experienced activity during pregnancy, while the rest were stable or improved. Postpartum exacerbation occurred in 25.8%. Pregnancy was planned in 87.1% of cases, with 35.5% receiving pre-pregnancy counseling; and 3.2% conceived via fertility treatment. There were four miscarriages and 28 live births, including twins. Delivery methods included 55,6% cesarean, 37% vaginal, and 7,4% assisted. Preterm births occurred in 3.2%, and 3.2% showed fetal distress. Healthy outcomes accounted for 87.1%, with 9.7% low birth weight, and no neonatal lupus cases, despite 16.1% anti-SSA antibody positivity. Regarding the use of disease-modifying antirheumatic drugs (DMARDs), 25.8% did not use DMARDs pre-pregnancy. Of those who did, 22.6% used hydroxychloroquine and 19.5% prednisolone. Sulfasalazine and methotrexate were used with the same frequency, while other medications were used in lower percentages. During pregnancy, 54.8% discontinued the use of DMARDs, and 45.2% continued them. Conclusions: Despite the challenges posed by rheumatic diseases, follow-up care in rheumatology enabled most women to have successful pregnancies, with 28 children born under our care in the past 15 years.
Introduction: Pregnancy in women with rheumatic diseases carries an increased risk of adverse maternal and fetal outcomes. However, real-world data indicate that, with proper planning, successful pregnancies are achievable. Objectives: To evaluate the impact of inflammatory rheumatic diseases on the pregnancies of patients followed by the Rheumatology Department of ULSG over the past 15 years. Materials and Methods: A cross-sectional, observational, descriptive study collected clinical data from the SClínico system for patients in the Rheumatology Department of ULSG who became pregnant post-diagnosis. Inclusion criteria: Women of childbearing age with a diagnosis of inflammatory rheumatic disease (rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, Sjögren’s syndrome, mixed connective tissue disease, or undifferentiated connective tissue disease) and a history of pregnancy. Exclusion criteria: Women with other rheumatic conditions not listed, pregnancies before diagnosis, or lack of consent. Clinical records were reviewed, cross-referencing rheumatology and obstetric appointments or admissions. Results: Twenty-four women met inclusion criteria, encompassing 31 pregnancies. The mean current age was 39.3±3.5 years; age at diagnosis was 29.4±6.2 years, and at delivery, 34.3±4.2 years. Among these women, 41,7% had rheumatoid arthritis, 16,7% axial spondyloarthritis, 12,5% spondyloarthritis with inflammatory bowel disease or Sjögren’s syndrome, and 4,2% had psoriatic arthritis, lupus, or other connective tissue diseases. During pregnancy, 71% had no comorbidities. The disease was active (using activity scores for each disease) in 16.1% at conception; 9.7% experienced activity during pregnancy, while the rest were stable or improved. Postpartum exacerbation occurred in 25.8%. Pregnancy was planned in 87.1% of cases, with 35.5% receiving pre-pregnancy counseling; and 3.2% conceived via fertility treatment. There were four miscarriages and 28 live births, including twins. Delivery methods included 55,6% cesarean, 37% vaginal, and 7,4% assisted. Preterm births occurred in 3.2%, and 3.2% showed fetal distress. Healthy outcomes accounted for 87.1%, with 9.7% low birth weight, and no neonatal lupus cases, despite 16.1% anti-SSA antibody positivity. Regarding the use of disease-modifying antirheumatic drugs (DMARDs), 25.8% did not use DMARDs pre-pregnancy. Of those who did, 22.6% used hydroxychloroquine and 19.5% prednisolone. Sulfasalazine and methotrexate were used with the same frequency, while other medications were used in lower percentages. During pregnancy, 54.8% discontinued the use of DMARDs, and 45.2% continued them. Conclusions: Despite the challenges posed by rheumatic diseases, follow-up care in rheumatology enabled most women to have successful pregnancies, with 28 children born under our care in the past 15 years.
Description
Keywords
Dmards Doenças Reumáticas Inflamatórias Gravidez Resultados Fetais Resultados Maternos