590: Pregnancy outcomes pre and post systemic autoimmune rheumatic diseases: a population-based cohort study

Abstract

To assess fetal and maternal outcomes pre and post a diagnosis of a systemic autoimmune rheumatic disease (SARD). We conducted a retrospective cohort study from a perinatal registry including all pregnancies in British Columbia from January 1st, 2002 to December 31st, 2012. SARDs was defined as one ICD-9/10 hospital code, or =/> 2 ICD-9/ICD-10 MSP codes at least 2 months apart in a 2 -year window. All connective tissue diseases were included: systemic lupus erythematosus, scleroderma/systemic sclerosis, Sjogren’s syndrome, dermatomyositis, polymyositis. SARDs exposure was based on diagnosis before or after date of conception. The groups were defined as post-SARDs (pregnancy following SARDs diagnosis) and pre-SARDs (pregnancy preceding SARDs diagnosis). Logistic, Cox and Poisson regression models evaluated the effects of SARDs on perinatal outcomes (small for gestational age [SGA], congenital anomalies [CA], preterm delivery, major infection in baby) and maternal outcomes (major infections). All models were adjusted for maternal prescription medications, comorbidities, prior pregnancy outcomes, and BMI. Of 405,538 total pregnancies, 1400 had SARDs. 1011 pregnancies were post-SARDs, and 389 were pre- SARDs. Odds ratios (OR) for the association of SARD’s with infants born SGA were increased for post- and pre-SARDs groups compared to non-SARDs pregnancies. The ORs for the association of SARDs with CA were increased only in the post-SARD’s group. Hazard ratios (HR) for the effect of post- and pre-SARDs on preterm delivery were increased. Count ratios (CR) for the association of SARDs with a serious newborn infection were increased only in the pre-SARDs group. No increased risk seen for serious maternal infections. Increased risk of SGA, CA and preterm delivery was found in patients with SARD’s. The risk of SGA, preterm delivery and newborn infections was increased prior to a SARD diagnosis. No association was seen between SARDs and maternal infections.