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Effect of Known and Previously Undiagnosed Undifferentiated Connective Tissue Diseases on Pregnancy Outcome

Fausta B, Elena L, Chiara C, Véronique R, Camilla B, Irene DM, Beatrice R, Carlomaurizio M and Arsenio S

Objective: Previously undiagnosed and known UCTDs are associated with severe obstetric and perinatal outcomes compared to controls.

Methods: Previously undiagnosed UCTDs and controls were screened using a two-step approach (selfadministered questionnaire and test for rheumatic autoantibodies) and evaluation by a rheumatologist. Pregnant subjects with known UCTD were recruited at the first trimester of pregnancy during their rheumatologic follow-up. Pregnancy complications such as preeclampsia, fetal growth restriction, small for gestational age, umbilical artery PI>95th percentile, prematurity<37 weeks ’gestation, were evaluated in cases and controls.

Results: Out of the 5199 women screened, 114 (2.2%) had a previously undiagnosed UCTD and 65 (1.25%) were diagnosed with major connective tissue diseases. Women with known UCTDs enrolled during first trimester were 78. Compared to controls, UCTD subjects, either previously undiagnosed and known, had increased rates of second trimester uterine artery bilateral notches, umbilical artery pulsatility index>95th percentile, and increased odds ratios of moderate to severe obstetric complications (respectively, OR 5.6 (CI 2.9-10.8) and OR 9.31 (CI 4.6-18.6)). Previously undiagnosed UCTDs, similarly to known UCTDs, were associated with the same risk of preeclampsia, respectively OR 6.3 (CI 2.4-16.7) and 6 (CI 2-18.3). UCTDs developed preeclampsia at earlier weeks (mean 32.5 vs 37.0 weeks) and delivered at earlier weeks (mean 35.5 vs 38.5 weeks) compared to control women.

Conclusions: Rheumatic autoimmune screening in pregnancy is useful because also minor connective tissue diseases, as previously undiagnosed UCTDs, could be complicated by obstetric adverse outcome, as preeclampsia.