Background/Purpose: SLE patients have poorer pregnancy outcomes than healthy patients, including a lower rate of live birth and higher rates of small for gestational age (SGA) infants, preeclampsia, hypertension, Cesarean delivery (C-section), neonatal intensive care unit (NICU) admissions, and prematurity. In contrast, there are limited data regarding pregnancy outcomes for women with undifferentiated connective tissue disease (UCTD). Most prior studies include pregnant women identified through a screening questionnaire from among healthy women, making these populations different from women with known UCTD who are followed by a rheumatologist.

Methods: Between 2008 and 2017, patients with UCTD and SLE at an academic medical center were recruited to a prospective pregnancy registry. UCTD was defined a positive autoantibody plus symptoms consistent with a connective tissue disease but not meeting criteria for another rheumatic diagnosis. SLE was defined by ACR or SLICC classification criteria. Data were collected prospectively at baseline, during pregnancy, and post-partum. Disease activity was determined by physician global assessment (PGA) score and classified as low, medium, or high. Differences in proportions were estimated by Fisher’s exact test. Differences in continuous variables were estimated by t-test or Wilcoxon rank-sum test, depending on the distribution of the data. Data were analyzed using SAS 9.4 (Cary, NC).

Results: We analyzed 51 UCTD pregnancies and 142 SLE pregnancies (Table 1). There were significantly more Caucasian patients with UCTD and significantly more black patients with SLE. Anti-Ro antibodies were the most common autoantibodies in both groups, and anti-RNP antibodies were second most common in the SLE group. Antiphospholipid syndrome was uncommon in both groups. Hydroxychloroquine was prescribed to most patients. A minority of UCTD patients and slightly less than 50% of SLE patients took steroids in any form. Disease activity was low in most patients, but the disease activity of SLE patients was higher. There was no significant difference in the rate of prematurity. More SLE patients had preeclampsia and SGA infants. Nearly 30% of infants born to SLE patients were admitted to the NICU. In models adjusted for race, having SLE was associated with an increased risk of preeclampsia, SGA, and preterm birth. One infant with complete heart block was born to a woman with SLE. Treatment with dexamethasone reversed early stage heart block in 5 cases.

Conclusion: Compared to women with SLE, women with UCTD have a lower rate of preterm delivery and preeclampsia, and their offspring are less frequently small for gestational age or admitted to the NICU. This data suggests that with appropriate screening, treatment, and monitoring, women with UCTD can have pregnancy outcomes comparable to those of healthy women.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-outcomes-in-undifferentiated-connective-tissue-disease-a-single-academic-centers-experience/