FRI0727 Impact of maternal systemic autoimmune rheumatic diseases on neonatal outcomes: a population-level analysis

Abstract

Objectives: We examined the association between SARDs and neonatal outcomes in a contemporary pregnancy cohort in the province of Alberta, Canada Methods: The patient population consisted of women giving birth between January 1, 2005 to December 31, 2014 (n = 312,081). For women with multiple gestations during the period, one birth event was randomly selected. Women with SARDs included any of the following: systemic lupus erythematosus (SLE), systemic sclerosis, myositis and sjogren's syndrome, diagnoses based on the presence of International Classification of Disease version 9/10 codes in outpatient or inpatient records. Baseline characteristics, comorbidities, medication use (available for all births after January 1, 2009), and neonatal outcomes among women with and without SARDs were compared. Results: Compared to women with no SARDs (n = 311,755), women with SARDs (n = 326, 0.1%) were slightly older (SARDs 31.3 vs No SARDs 29.3 years (p < 0.01)) but did not differ in terms of rural residence, ethnicity, median household income or nulliparity. Of the 326 women with SARDs, 271 (83.1%) had SLE, 53 (16.3%) had systemic sclerosis, 26 (8%) had dermatomyositis, 17 (5.2%) had polymyositis and 29 (8.9%) had sjogren's syndrome. Rates of pre-term delivery, emergent caesarean section, induction, hypertensive disorders/eclampsia and mortality were higher among women with SARDs than those with no SARDs. Offspring of women with SARDs had lower birth weights, were more likely to have small for gestational age babies (SGA), and had longer stays in neonatal ICU. Among women with SARDs, prescription rates in the 270 days prior to delivery were highest for anti-malarials (25.1%) followed by steroids (16.3%). Regarding the impact of medication use during pregnancy, the unadjusted odds ratio was signifi-cant for steroids on preterm delivery (OR 3.84 (95% CI 1.66, 8.89, p < 0.05) and hypertensive disorders of pregnancy (OR 3.67 (95% CI 1.51, 8.93), p < 0.05); for nonsteroidal anti-inflammatories, the unadjusted odds ratio was significant for preterm delivery (OR 4.96 (95% CI 1.55, 15.85, p < 0.05). Antimalarials did not have an impact on pregnancy related outcomes in the unadjusted analysis. After multivariable adjustment, both NSAID use (OR (95% CI): 5.24 (1.57, 17.52), p < 0.01) and steroid use (OR (95% CI): 3.15 (1.31, 7.59), p < 0.01) were significantly associated with a higher risk of preterm delivery. Conclusion: Women with SARDs are at an increased risk of adverse outcomes during pregnancy. The association between corticosteroid and NSAID use and preterm delivery requires further investigation. Our findings suggest the need for closer monitoring and coordinated care with obstetrics and perinatology in these high risk women.