O2. Patient Awareness of Risks and Clinical Outcomes Associated with Connective Tissue Diseases in Pregnancy: A Cross Sectional Study

Abstract

Background: Patients with CTD are considered to have a high risk of adverse pregnancy outcomes. Risks may be related to disease activity, medications and/or autoantibody profiles. Current guidelines suggest careful pre-conceptual planning and MDT management for these high-risk pregnancies. Current data have indicated that poor pregnancy planning and lack of patient awareness may have serious implications on pregnancy outcomes. The aim of this study was to assess pregnancy outcomes and patients' awareness of diseaserelated risks in a secondary care setting of patients with CTDs. Methods: A cross sectional study retrospective case note review of 45 patients with SLE, Sjögren's or APS, was undertaken in addition to a patient survey of awareness of pregnancy risks associated with CTDs. Results: Sixty episodes of conception were recorded in 27/45 women (60%) with 44 live births (73.3%). Adverse pregnancy outcomes were recorded in 15 women (55.5%) which included disease flare up in 3 cases (11.1%), high blood pressure and pre-eclampsia in 2 cases each (7.4%), 11 episodes of miscarriages (18.3), termination of pregnancy in 5 pregnancies (8.3%), premature delivery in 4 pregnancies (6.6%) and intra-uterine growth retardation in 3 pregnancies (5%). There was a high rate of pregnancy complications in the LN (n=5/7) (71.4%) and APS (n=6/10) (60%) subgroups. Fetal heart block was recorded in two fetuses born to mothers with anti-Ro/SSA and anti-La/SSB antibodies (n=14). One third of women had preconception counselling recorded and 22% had consultant-led obstetric antenatal care. A postal patient survey was returned by 8/45 (17.8%) women and demonstrated poor patient awareness of the pregnancy risks associated with CTDs (87.5%) and medications (75%). Conclusion: Despite a high rate of adverse pregnancy outcomes, this study has demonstrated that few patients with CTD in district general hospitals have consultant led or MDT obstetric care. Furthermore, a significant number of patients denied knowledge of the risks associated with their diseases and medications. There is a need for increased emphasis on patient education within this high-risk population and early identification of these patients to enable MDT antenatal care as is the recommended best practice.