Resultados obstétricos en una consulta multidisciplinar de mujeres embarazadas con enfermedades reumáticas autoinmunes sistémicas y trombofilias hereditarias

Résumé

INTRODUCTION Rheumatic diseases (RD) and hereditary thrombophilias (HT) can be associated with high-risk pregnancies. The main objective of this study is to describe the gestational episodes seen in a multidisciplinary consultation (MC) of pregnant women with RD and primary HT. METHODOLOGY Retrospective observational study based on clinical practice data. These ones were recorded in a database of pregnant women with RD and primary HT attended in a MC and consecutively followed up at the Hospital Universitario Virgen de las Nieves in Granada between January 2012 and May 2018. Analysis of baseline variables before MC can was performed by women (n=143) and analysis of follow-up variables by gestation episodes (n=198). This study describes successful gestational outcomes with newborns, adverse gestational outcomes (miscarriages and foetal deaths), neonatal complications and maternal complications during MC care. Adverse gestational outcomes during standard care (pre-MC) were compared with those recorded during MC. For this comparison, the absolute risk reduction (ARR) and the number of needed women to treat (NNT) were calculated. RESULTS A total of 198 pregnancies belonging to 143 women (112 with RD and 31 with HT). There were 191 (96.5%) successful gestational outcomes and 7 (3.5%) adverse gestational outcomes during MC (5 miscarriages and 2 foetal deaths). Results during standard care (pre-MC) showed that 60.8% of women had more than one miscarriage and 4.2% some foetal death. In contrast, after MC care, for every 100 women treated at MC, there were 57.3% fewer miscarriages and 2.8% fewer foetal death than would have occurred if they had not been treated at MC, according to the ARR, 95% CI [48.8-65.9] (p_value < 0.001) and 95% CI [1.1-6.6] (p_value = 0.289) respectively. The NNT to prevent miscarriage was 1.74; 95% CI [1.5-2.1] and to prevent foetal death NNT = 35.75 95% CI [15.2-90.9]. 84.8% of newborns and 93.3% of women did not experience any complication during the MC care. CONCLUSIONS This study aims to show the high rate of successful gestational outcomes, as well as the drastic reduction of adverse gestational outcomes after care in a MC integrated by rheumatologists, internists, obstetricians, hematologists, nephrologists, pediatricians and/or neonatologists. These results are even more significant in a population with a high percentage of adverse outcomes during standard care prior to the MC. These results could be useful for the promotion of MC in the management of pregnancies in women with RD and HT.