413. Comparing patients with inflammatory and non-inflammatory arthritic conditions in pregnancy. A retrospective analysis of a single centre in London. 2012–2015

Autor: Natasja dr Vanderpitte, Oseme dr Etomi, Shohreh dr Beski, Maria Bickerstaff
Rok vydání: 2018
Předmět:
Zdroj: Pregnancy Hypertension. 13:S148
ISSN: 2210-7789
DOI: 10.1016/j.preghy.2018.08.440
Popis: Introduction Rheumatic conditions are either inflammatory (IA): rheumatoid arthritis (RA), psoriatic arthritis (PSA) and ankylosing spondylitis (AS) or non-inflammatory (NIA): ehlers-danlos (EDS), benign joint hypermobility syndromes (BJHS), fibromyalgia (FM), chronic lower back pain (LBP) and osteoarthritis (OA). Both cause pain but co-morbid IA in pregnancy is historically associated with a higher risk of adverse outcomes for mother and child. Objectives We evaluate our experience of managing women with IA and NIA to highlight differences and similarities. Methods In our unit, pregnant women with rheumatic conditions are reviewed in a joint obstetric-rheumatology clinic. We retrospectively analysed health-records of all patients from 2012–2015, focusing on disease activity, obstetric and neonatal outcomes. Results were analysed in excel. Results 53patients with IA (23:RA, 11:PSA, 10:AS) and 24patients with NIA (9:EDS, 6:BJHS, 6:FM, 1:LBP, 1:OA, 1:congenital hip dysplasia) were identified. 7patients were excluded (incorrect diagnosis or incomplete medical records). Mean age: 33 vs. 31 years and mean gestational age: 38 + 3 vs. 37 + 1 (IA vs. NIA). Despite babies of IA mothers born 1 week later, average birthweight was comparable (3,170 kg vs. 3,130 kg). Spontaneous vaginal delivery (SVDs) rates were significantly higher in IA patients: 75% v. 41.7% (p-value 0.009) and caesarean section rates (CS) higher in the NIA patients: 25% v. 58.8% (p-value 0.009); elective-CS: 10% vs. 38.8% and emergency-CS: 15% v. 20%. Disease activity was lower antenatally (48%:RA, 27%:PSA, 0:AS) compared with post-partum (65%:RA, 54%:PSA, 50%:AS) in IA patients. There were no documented flares in the NIA patients. Discussion Measured outcomes were favourable in both groups are a likely reflection of improvements in IA treatment. Babies of IA mothers were however smaller for dates as compared with NIA. Surprisingly, women with IA were more likely to undergo SVD. This may reflect higher perceptions/fears about pain in NIA patients. To understand these trends better, prospective multi-centre studies are welcome.
Databáze: OpenAIRE
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