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PREGNANCY IN RHEUMATOID ARTHRITIS IN ROMANIA
Background. The new therapies have enforced another approach regarding the success of a pregnancy in rheumatoid arthritis, in a sense of a decrease in the number of complications which may interfere with the fetal or maternal outcome.
Aims. The study aim is to evaluate fertility among female patients with rheumatoid arthritis, in Romania, having as secondary objectives to appraise the pregnancy outcome, in parallel with monitoring the activity of the disease, the relation with the postpartum flare, as well as following up on the evolution status of the foetuses.
Material and method. We have analysed a number of 38 female patients diagnosed with rheumatoid arthritis that have had at least one post-diagnosis obstetrical episode, for 23 of the patients we have done it retrospectively, and for 15 patients, prospectively. The study is multicentric and has been carried out between October 2012 and July 2015. The patient evaluation criteria include: the activity of the disease and the treatment management in the pre-conceptual stage; monitoring of the disease every trimester and adequate therapeutic intervention; postpartum reactivation of the rheumatoid arthritis in connection with the breast feeding and the control of the disease during pregnancy: teratogenicity and autoimmunity bearing risks over the product of conception; outcome of pregnancies and foetuses.
Results. The 38 women have had an average age at conception of 31.02 years, at almost 6 years from diagnose and we have obtained a number of 67 pregnancies with the following outcome: 31 births at term, 3 premature births, 12 elective abortions and 21 spontaneous abortions. The pregnancy has been planned in 47.77% of cases. Patients have been exposed during preconception as well as during pregnancy at synthetic and biological disease-modifying antirheumatic drugs. During preconception, the activity of the disease was controlled for half of the patients, status that has been kept or improved during pregnancy and only 3 cases have shown a minimal reactivation. The length of the pregnancies was about 34.94 weeks, the average weight at birth was of 2,668 grams. No foetal anomalies have been identified. The postpartum flare has occurred after 9.7 weeks and in 9 of the patients we have not recorded an increase in the degree of activity of the disease.
Conclusions. The rheumatoid arthritis is not a contraindication to pregnancy, as the activity of the disease is controlled or partially controlled during the pregnancy with or without antirheumatic therapies, but the risk of an early postpartum relapse remain possible, the majority of pregnancies have a positive outcome.
Discussion. The data obtained in our country are in general superposable to the data found in the specialized literature. Giving good pre-conceptional counselling and having an eficient interdisciplinary management of pregnancies are the key elements for successfully covering this chapter in the life of our female patients.
Keywords: rheumatoid arthritis, pregnancy, fetal outcome, disease activity