PS4:83 Follow-up of newborn babies from mother affected by systemic autoimmune disease

Abstract

Introduction Most autoimmune systemic diseases affect more frequently females in reproductive age, suggesting the need to consider the possible effect on some important aspects of women’s life such as fertility and pregnancy, but above all possible outcomes on the newborn and, subsequently, on the child. Topic of this study is the analysis of the neonatal and long-term paediatric outcomes, until school age, of a group of paediatric subjects born from mother affected by systemic autoimmune disease, in care at the Department of Neonatology and Paediatrics of the Mauriziano Hospital of Turin, in order to identify any associations with pregnancy and the type and activity of maternal disease. Materials and methods From October 2016 all women in care at the Department of Immunology of the Mauriziano Hospital, aged between 25 and 45, who had one or more pregnancies hesitated in the birth of alive baby during January 2002 and October 2015, have been enrolled in this study. We have considered, for each pregnancy (n=48): type of maternal disease (with antibody dosage), obstetric outcomes (type of delivery, indication to caesarian section, gestational age at birth), neonatal outcomes (Apgar score, low neonatal weight, fetal growth restriction, neonatal complications), clinical-diagnostic management of babies (hematologic and other examinations required) and long-term paediatric outcomes (psychomotor development alterations, chronic diseases, hematologic alterations, hospital admissions). Results In our study we have observed a greater incidence of preterm birth (33%) and caesarian section (68%), compared to reference healthy population of the same hospital Department. We also observed, in association with maternal therapy taken during pregnancy, a significant difference of the incidence of preterm birth (p=0,0005) and a weakly significant difference of the incidence of low neonatal weight (p=0,0596). We haven’t notice any significant difference, in association with antibody positivity, of the incidence of low birth weight and fetal growht restriction and not even in the incidence of neoantal complications. Regarding the long-term paediatric follow-up, we have notice a greater incidence of psycomotor development alterations in association with ENA antibody positivity (28% vs 0%), with a statistically significant difference (p=0.0155). Conclusions Data from the retrospective analysis, in agreement with literature, confirm a greater incidence of caesarian section (most of cases programmed), preterm birth and low birth weight in this category of newborns. For the first time it was considered the association between neonatal and paediatric outcomes and the maternal tharapy during pregnancy: we have notice a significant greater incidence of preterm birth in newborns from mother who have taken therapy during pregnancy. Regarding the long-term paediatric follow-up, until school age, in agreement with the few data in the literature, it was observed a greater incidence of psychomotor development alterations in children born from mother with antibody positivity (aPL ed ENA). Our data notice a poor adherence to practical recommendations of the clinical management and the follow-up of these children present in the literature. We have set up a national survey in order to verify current knowledge and to sensitise Paediatricians and Neonatologists regarding this category of children, that need a specific clinical management and follow-up. Since limits of a retrospecive study and the relative small population size, we started a case-control prospective study with a wider population size, currently in the recruitment phase, in order to validate data observed in the retrospective analysis and to verify the current adhesion to raccomandations of the follow-up. We hope that a greater knowledge of the topic, together with the establishment of common clinical practices, can bring to an improvement of obstetric, neonatal and long-term paediatric outcomes in children born from mother with systemic autoimmune disease.