Pregnancy outcomes for women with rare autoimmune diseases

Abstract

Objective: To examine pregnancy outcomes and pregnancy-related health service utilisation among women with rare autoimmune diseases. Methods: This population-based cohort study of an Australian obstetric population (New South Wales 2001-2011) used birth records linked to hospital records for identification of rare autoimmune diseases including systemic vasculitis, vasculitis limited to skin, systemic sclerosis, dermatopolymyositis and other systemic involvement of connective tissue. We excluded births to women with systemic lupus erythematosus or rheumatoid arthritis and births >6 months before the first documented diagnosis of the rare autoimmune disease. Modified Poisson regression was used to compare study outcomes between women with autoimmune diseases and the general obstetric population. Results: There were 991,701 births including 409 (0.04%) births to 293 women with rare autoimmune diseases. Of the 409 pregnancies, 202 (49%) delivered by cesarean delivery and 72 (18%) were preterm; these rates were significantly higher than those in the general obstetric population (28% and 7% respectively). Compared to the general population, women with autoimmune diseases had higher rates of hypertensive disorders, antepartum hemorrhage and severe maternal morbidity, and required longer hospitalization at delivery and more hospital admissions and tertiary obstetric care. Compared to other infants, those whose mothers had a rare autoimmune disease were at increased risk of admission to neonatal intensive care unit, severe neonatal morbidity and perinatal death. Conclusions: Women with rare autoimmune diseases were at increased risk of having both maternal complications and adverse neonatal outcomes; their pregnancies should be closely monitored.