Rheumatology (Oxford, England) · 2025
Beyond pregnancy in systemic autoimmune diseases: a focus on postpartum experience from a referral centre.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zucchi Dina, Ciribè Benedetta, Monacci Francesca, Elefante Elena, Ietto Chiara, Cascarano Giancarlo, Gori Sabrina, Gelsi Valentina, Mosca Marta, Tani Chiara
Аннотация
OBJECTIVE: To evaluate the incidence and types of complications occurring within 60 days postpartum in patients with systemic autoimmune diseases (SAD), focusing on disease flares and other clinical events.
METHODS: This is a retrospective analysis of prospectively collected data from a single-centre cohort. Variables included demographic and clinical features, pregnancy treatments, disease course, postpartum visit attendance, complications and breastfeeding data.
RESULTS: A total of 253 pregnancies were included. Most diagnoses were connective tissue diseases (CTDs, 80.2%), followed by inflammatory arthritis (14.2%) and vasculitis (5.5%). A postpartum visit was performed in 234 patients (92.5%). Postpartum complications occurred in 50 patients (19.8%), including 42 flares (16.6%) and 12 other complications (4.7%). Flares included 20 articular, five mucocutaneous, five renal, four hematological, three parotid swelling, two deep venous thromboses in aPL-positive patients, two uveitis relapses and one myositis. Flares were associated with active disease during pregnancy (P < 0.01). Inflammatory arthritis showed the highest flare rate (41.7% vs 12.0% in CTD, P < 0.01), though severe flares occurred only in CTD or vasculitis. Other complications included six hypertension cases, four postpartum hemorrhages (two on LDA/LMWH), one Clostridium difficile infection and one ICU admission for severe hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Non-flare complications did not differ by diagnosis. At postpartum visit, 147 patients (58.5%) were breastfeeding. Of the 42 with flares, four were contraindicated to breastfeed due to therapies. The others who did not breastfeed did so by choice or unrelated reasons.
CONCLUSIONS: The postpartum period is high-risk in SAD patients. Follow-up should extend beyond pregnancy, with multidisciplinary care to manage disease activity and breastfeeding-related treatment restrictions.
METHODS: This is a retrospective analysis of prospectively collected data from a single-centre cohort. Variables included demographic and clinical features, pregnancy treatments, disease course, postpartum visit attendance, complications and breastfeeding data.
RESULTS: A total of 253 pregnancies were included. Most diagnoses were connective tissue diseases (CTDs, 80.2%), followed by inflammatory arthritis (14.2%) and vasculitis (5.5%). A postpartum visit was performed in 234 patients (92.5%). Postpartum complications occurred in 50 patients (19.8%), including 42 flares (16.6%) and 12 other complications (4.7%). Flares included 20 articular, five mucocutaneous, five renal, four hematological, three parotid swelling, two deep venous thromboses in aPL-positive patients, two uveitis relapses and one myositis. Flares were associated with active disease during pregnancy (P < 0.01). Inflammatory arthritis showed the highest flare rate (41.7% vs 12.0% in CTD, P < 0.01), though severe flares occurred only in CTD or vasculitis. Other complications included six hypertension cases, four postpartum hemorrhages (two on LDA/LMWH), one Clostridium difficile infection and one ICU admission for severe hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Non-flare complications did not differ by diagnosis. At postpartum visit, 147 patients (58.5%) were breastfeeding. Of the 42 with flares, four were contraindicated to breastfeed due to therapies. The others who did not breastfeed did so by choice or unrelated reasons.
CONCLUSIONS: The postpartum period is high-risk in SAD patients. Follow-up should extend beyond pregnancy, with multidisciplinary care to manage disease activity and breastfeeding-related treatment restrictions.