Search Results (25)

Chronic inflammatory barrier diseases (CIBDs) affect many women of reproductive age, yet the safety of biologics during pregnancy remains inadequately investigated. This retrospective cohort study used the US Collaborative Network of TriNetX to evaluate the risk of adverse pregnancy outcomes (APOs) among women with CIBD receiving tumor necrosis factor inhibitors (TNFis), interleukin-23 inhibitors (IL-23is), or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), compared with untreated CIBD controls and the general pregnant population. Among 1842 pregnant women with CIBD receiving systemic therapy, 1188 were exposed to TNFis, 170 to IL-23is, 370 to azathioprine (csDMARD), and 114 to methotrexate (MTX) (csDMARD). The incidence of any APO ranged from 11% in untreated CIBD controls to 19% with ustekinumab (IL-12/23i). Among treatment groups, rates were 17% with TNFis, 18% with IL-23is, 13% with azathioprine, and 15% with MTX, compared with 17% in the general pregnant population. APO rates were comparable between the overall TNFi group and the TNFi group excluding certolizumab pegol (CZP) (TNFi). In the only non-exploratory comparison, TNFi exposure was associated with higher risks of (pre-)eclampsia and hypertension but a lower risk of abortion or intrauterine death versus CIBD controls, with no significant difference for overall APO. No treatment group showed a markedly increased overall APO risk, supporting tailored decision-making that balances the consequences of uncontrolled maternal disease against individual treatment-associated risks. Full article

Primary Sjogren’s Disease (SjD) is characterized by features of dryness arising from inflammation in the secretary glands, particularly the salivary and lachrymal glands. Generalized symptoms of fatigue and limb pain are very common but, in addition, about 40% of patients have one or more features of organ-specific systemic disease. This review goes through the background of SjD including diagnosis and classification, epidemiology, impact and investigations such as ultrasound and lip biopsy. It then focuses in detail on each of the systemic organ-specific features, principally using the European League against Rheumatism (EULAR) Sjogren’s Syndrome Disease Activity Index (ESSDAI) along with some non-ESSDAI domains, before concluding with comments on disease heterogeneity, treatment, vaccination, pregnancy and surgery along with observations on patient perspectives. The aim is to provide a general overview of these aspects of the disease to complement other chapters in this monograph. Full article

Background: Autoimmune rheumatic diseases, including systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), Sjögren’s syndrome, systemic sclerosis (SSc), and rheumatoid arthritis (RA), pose significant challenges during pregnancy and are associated with increased risks of adverse maternal and fetal outcomes, such as preeclampsia, fetal growth restriction (FGR), miscarriage, and preterm birth. The aim of this review is to synthesize recent evidence on pregnancy-related risks, preconception counseling, and therapeutic strategies for these conditions, with a particular focus on the importance of disease remission, pregnancy-compatible medications, and the selective use of biologics. Methods: A structured narrative review was conducted through a comprehensive PubMed search (2020–2025). Eligible studies addressed maternal–fetal outcomes, therapeutic approaches, and predictive factors in pregnant individuals with autoimmune rheumatic diseases. Results: Pregnancy outcomes have improved with early disease control and multidisciplinary care; however, major challenges persist. These include limited access to novel therapies, underrepresentation of diverse populations in clinical trials, and insufficient data on long-term neonatal outcomes. The strongest predictors of adverse outcomes remain disease activity at conception, specific autoantibody profiles, and systemic organ involvement. Conclusions: Optimal pregnancy outcomes for women with autoimmune rheumatic diseases require coordinated multidisciplinary care, the use of pregnancy-compatible medications, and achievement of prolonged disease remission prior to conception. Further research is needed to close existing knowledge gaps and ensure equitable, high-quality maternal–fetal care. Full article

Objective: This study aims to evaluate obstetric and neonatal outcomes in pregnancies complicated by RDs and to identify hemogram-derived biomarkers associated with adverse perinatal events. Methods: This retrospective cohort study analyzed 360 pregnancies in individuals diagnosed with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), ankylosing spondylitis (AS), Sjögren’s disease, sarcoidosis, undifferentiated connective tissue disease (UCTD), and other autoimmune conditions, followed up at the Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, between 2013 and 2018. Data on disease activity, maternal complications, neonatal outcomes, and inflammatory markers were extracted from electronic medical records. Results: Patients with SSc had the highest rates of preterm birth (57.1%) and fetal growth restriction (FGR) (42.9%), whereas those with SLE (50%) and AS (25%) exhibited the highest disease flare rates. Neonates born to mothers with SSc, SLE, and Sjögren’s disease had significantly lower Apgar scores, suggesting increased neonatal distress. NICU admission was associated with elevated neutrophil-to-lymphocyte ratio (NLR) and eosinophil-to-lymphocyte ratio (ELR), with higher NLR and ELR also predicting spontaneous abortion. Monocyte-to-lymphocyte ratio (MLR) and ELR demonstrated the highest predictive value for composite adverse perinatal outcomes. Additionally, RA patients experiencing disease flares had an 87.5% cesarean section (CS) rate, significantly exceeding the general population rate. Conclusions: This study underscores the increased risk of preterm birth, FGR, and neonatal complications in RD pregnancies, particularly in SSc and SLE patients. The findings suggest that early risk assessment using hemogram-based inflammatory markers may improve perinatal management and patient stratification. Full article

Viscum coloratum (Komar.) Nakai (V. coloratum) is a traditional Chinese herbal medicine. It is used in treating rheumatism and paralysis, lumbar and knee soreness, weakness of the muscles and bones, excessive leakage of menstruation, leakage of blood in pregnancy, restlessness of the fetus, dizziness and vertigo. All information about V. coloratum was collected through databases such as PubMed, Google Scholar, Web of Science, and the China National Knowledge Infrastructure and supplemented by consulting classical Chinese medical books. To date, 111 compounds have been isolated and identified from V. coloratum, including flavonoids, phenylpropanoids, terpenoids, diarylheptanoids, alkaloids, other components, and macromolecular compounds, such as polysaccharides and lectins. These chemical components exhibit anti-inflammatory, anticancer, antioxidant, and anti-cardiovascular disease effects, among other beneficial effects. According to the reports, alkaloids, lectins, and other chemical components present in V. coloratum may induce toxicity due to excessive intake or accidental ingestion. However, there are few reports on the toxicology of V. coloratum, and there is a lack of studies on the toxicity of V. coloratum with known in vitro or preclinical activity. It is suggested that further studies on the toxicology of V. coloratum should be conducted in the future. In this paper, the botany, traditional uses, phytochemistry, pharmacology, and pharmacokinetics of V. coloratum are summarized, and the progress and shortcomings in toxicology are discussed, so as to provide a possible direction for future research on V. coloratum. Full article

Background and Objectives: Canakinumab, a human recombinant monoclonal antibody against interleukin-1ß (IL-1ß), is indicated for the treatment of selected autoinflammatory periodic fever syndromes and rheumatic diseases. Data on its use during pregnancy remain limited and all are primarily derived from case reports. Although animal studies indicate no evidence of reproductive toxicity, the risk to the fetus or mother remains unknown. This study aims to provide more findings about this important topic. Methods: A retrospective analysis was conducted on three patients followed and treated in the National Center for Periodic Fever Syndromes. Although due to the small sample size, no general conclusions regarding the safety of canakinumab during pregnancy can be drawn. Results: Three maternal-exposed pregnancies were assessed, with no paternal exposure. Diagnoses included mevalonate kinase deficiency, familiar Mediterranean fever and TNF-receptor-associated periodic syndrome. All mothers were treated with canakinumab, and two of those continued the canakinumab treatment during the whole course of pregnancy. The diseases remained under full control during pregnancy, enabling conception in two cases where attempts prior to treatment were unsuccessful. The therapy led to disease control, a reduction in inflammation and subsequently successful conception. One patient underwent IVF repeatedly. All pregnancies resulted in three healthy infants, with no reported miscarriages during the canakinumab-exposed pregnancies, no complications during pregnancies and no serious infections in the newborns. The children had normal development, without any developmental delays or chronic illnesses. Conclusions: The current data, including our findings, indicate no harmful effects of canakinumab during pregnancy. However, because of the scarcity of data, the use of canakinumab during pregnancy should be carefully managed, and women who want to become pregnant should continue treatment only after a thorough benefit–risk evaluation. Full article

The data about pregnancy while having a low ejection fraction are scarce, since pregnancy is not recommended for women with an ejection fraction of less than 30%. There is an increased risk of obstetrical complications and adverse maternal-fetal outcomes. Pregnancy is a rough journey for this group of patients. However, a successful pregnancy can be achieved when cardiac complications are managed during pregnancy. The early recognition of women at risk of cardiovascular events and early referral can optimize the maternal and neonatal outcomes with close collaboration between the maternal-fetal medicine specialist and the cardiologist. The study’s aim was to assess the experience of our tertiary center with regard to the adverse maternal outcome for women with an ejection fraction ≤ 30% compared to those with an EF > 30% in our tertiary center. The fetal and obstetric outcome for pregnancies with an EF ≤ 30% was compared to that for pregnancies with an EF > 30%. Methodology: After receiving the approval of the local Ethical Board Review, a retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSHRC) in the city of Riyadh, Kingdom of Saudi Arabia. Our study population included women with cardiomyopathy (acquired or congenital) who were followed up or delivered in KFSHRC from the period of January 2004 till March 2020. Cases were identified by reviewing the database from the Cardiac Center Echocardiograph and maternal fetal medicine unit. The data on the maternal and fetal outcome were gathered from the hospital medical records. An adverse maternal outcome included: death, hospitalization due to decompensated heart failure, and worsening cardiovascular status during pregnancy. Adverse fetal outcomes included: miscarriages, termination of pregnancy, FGR, and placental insufficiency. Obstetrics complications included: complications related to the mode of delivery, antepartum hemorrhage, postpartum hemorrhage, or preeclampsia. Results: Our study included 44 subjects, examining the differences between those with an ejection fraction greater than 30 (n = 21 subjects) and those with an ejection fraction less than or equal to 30 (n = 23) with respect to demographics, co-morbidities, and outcomes (maternal, pregnancy, fetal, ultrasound, and baby). There was no evidence of any differences in the demographics. From among the co-morbidities, there was a statistically higher rate of dilated cardiomyopathy and lower rate of rheumatic heart disease in those with a lower ejection fraction. Also, women with a lower ejection fraction tended to deliver through a means other than simple vaginal delivery. There was a significant association (p = 0.0296) indicating that individuals with a lower ejection fraction tended to have a lower gestational age at delivery. The information on whether the pregnancy resulted in a live birth was available for all but one of the mothers. Across all the mothers, 32 (74%) resulted in a live birth and 11 did not. The percentage of pregnancies resulting in a live birth in the group for which the ejection fraction was greater than 30 was 90% and that in the group for which the ejection fraction was less than or equal to 30 was 59% (p = 0.0339). From among the ultrasound and baby outcomes, only the rate of the babies being discharged alive differed statistically between the two ejection fraction groups, with those mothers having a lower ejection fraction experiencing fewer babies being discharged alive (p = 0.0310). Conclusions: In conclusion, women with a low ejection fraction are at an increased risk of maternal-fetal complications. In our study, the lower the EF (≤30) the worse were the fetal and neonatal outcomes; however, in terms of the maternal outcomes, it was the same whether the EF was low or ultra-low. Yet, these groups of patients need to be counseled about the facts of poor obstetrical outcomes with an emphasis on preconceptual counseling. Full article

Objectives: Current guidelines recommend systematic screening for rheumatic diseases (RDs), including antiphospholipid syndrome (APS), in patients with recurrent pregnancy loss (RPL). However, these recommendations are based on limited evidence, as data on the prevalence of RD in this specific population remain scarce. In particular, the impact of the recent update to the ACR/EULAR classification criteria for APS on the prevalence of RD among RPL patients has yet to be clarified. To address these gaps, this study aims to (i) assess the impact of the 2023 ACR/EULAR APS classification criteria in patients with recurrent pregnancy loss (RPL); and (ii) analyze the prevalence of RD in these patients. Methods: We conducted a retrospective cohort study at Rennes University Hospital. From January 2010 to December 2021, all patients referred to the Clinical Immunology Department for RPL were included. Patients were eligible if they had undergone a full RPL evaluation, according to guidelines. Results: We included 165 women with RPL. APS according to the Sydney criteria was found in 24 (14.5%) patients. No significant differences in obstetric history or clinical signs were observed between APS-positive and APS-negative individuals. Only two patients fulfilled the updated 2023 APS criteria, resulting in 163 (98.8%) patients being classified as having unexplained recurrent pregnancy loss (uRPL). Among them, 108 had a new pregnancy following uRPL, resulting in 87 (81%) live births and 21 (19%) recurrent miscarriages. We did not identify any prognostic factor associated with subsequent pregnancy outcomes, including the patients’ antiphospholipid biological profile. We found a prevalence of non-APS RD of only 2.4% in the study population, including systemic lupus erythematosus, rheumatoid arthritis, and Behçet’s disease. Conclusions: APS was identified in 14.5% of the patients based on the former Sydney criteria and 1.2% according to the revised criteria. The lack of clinical differences between APS and non-APS patients aligns with previously reported limitations of the Sydney criteria in accurately identifying aPLA-related RPL. According to the rarity of APS as per the updated criteria, future large collaborative trials will be needed to further characterize APS-related RPL patients and to determine the best treatment strategy for future pregnancies. Full article

Background/Objectives: We assessed the effectiveness and safety of vitamin K antagonists (VKAs) versus direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) using artificial intelligence techniques. Methods: This is a retrospective study in 15 Spanish hospitals (2014–2020), including adult AF patients with no history of anticoagulation, thrombosis events, rheumatic mitral valvular heart disease, mitral valve stenosis, or pregnancy. We employed EHRead^® technology based on natural language processing (NLP) and machine learning (ML), along with SNOMED-CT terminology, to extract clinical data from electronic health records (EHRs). Using propensity score matching (PSM), the effectiveness, safety, and hospital mortality of VKAs versus DOACs were analyzed through Kaplan–Meier curves and Cox regression. Results: Out of 138,773,332 EHRs from 4.6 million individuals evaluated, 44,292 patients were included, 79.6% on VKAs and 20.4% on DOACs. Most patients were elderly [VKA 78 (70, 84) and DOAC 75 (66, 83) years], with numerous comorbidities (75.5% and 70.2% hypertension, 47.2% and 39.9% diabetes, and 40.3% and 34.8% heart failure, respectively). Additionally, 60.4% of VKA and 48.7% of DOAC users had a CHA2DS2-VASc Score ≥4. After PSM, 8929 patients per subgroup were selected. DOAC users showed a lower risk of thrombotic events [HR 0.81 (95% CI 0.70–0.94)], minor bleeding [HR 0.89 (95% CI 0.83–0.96)], and mortality [HR 0.80 (95% CI 0.69–0.92)]. Conclusions: Applying NLP and ML, we generated valuable real-world evidence on anticoagulated AF patients in Spain. Even in complex populations, DOACs have demonstrated a better safety and effectiveness profile than VKAs. Full article

Background/Objectives: ACR/EULAR has recently developed new classification criteria for antiphospholipid syndrome (APS). The present study aims to analyze the impact of these new 2023 ACR/EULAR classification criteria in a cohort of pregnant women with primary APS. Methods: Retrospective cohort study of 93 consecutive pregnant women attending the Autoimmune Diseases Pregnancy Clinic, a multidisciplinary unit of a tertiary care teaching hospital, between 2005 and 2023. All of them fulfilled the Sydney classification criteria for APS. Women diagnosed with rheumatic autoimmune diseases other than APS were excluded. Results: Twenty-four out of ninety-three patients (25.8%) met the 2023 ACR/EULAR criteria for APS. Patients who met the new classification criteria were very similar to those who did not, except for being younger (p < 0.001), and had a lower number of clinical pregnancies (p = 0.004). The obstetric domain was clearly underrepresented in women who fulfilled the 2023 ACR/EULAR criteria (p < 0.001). Patients meeting the new classification criteria were primarily characterized by preterm births before 34 weeks due to severe placentation disorders (p = 0.004). Women with early and late fetal loss were significantly underrepresented (p < 0.0001 and 0.03, respectively). Nearly half of these patients had thrombocytopenia (p < 0.001). Serologically, these patients showed a higher frequency of persistent lupus anticoagulant (p = 0.02) and a lower frequency of IgM isotype antiphospholipid antibodies (p = 0.05). Conclusions: Almost three-quarters of the patients included in the study did not meet the 2023 ACR/EULAR criteria. Most patients who could not be classified according to these new classification criteria were those with early and/or late fetal deaths, as well as patients carrying only IgM aCL/AB2GPI antibodies. The high specificity of the 2023 ACR/EULAR criteria, restricted to severe placentation disorders, may leave the majority of patients with obstetric APS out of the new classification criteria. Full article

Patients with rheumatic diseases frequently operate with incomplete or incorrect information while planning for and experiencing pregnancy, often due to variability in provider care and knowledge. Risk assessment at each stage of pregnancy—pre-conception, during pregnancy, and postpartum—is focused on reducing maternal and neonatal complications. This review aims to compile updated, evidence-based guidance on how to minimize risk factors contributing to adverse pregnancy outcomes (APOs). Mitigation of known causes of infertility, appropriate testing and monitoring, achieving low disease activity on pregnancy-safe disease-modifying antirheumatic drugs (DMARDs) prior to conception, controlling hypertension (a frequent comorbidity among patients with certain rheumatic diseases), and the use of appropriate adjunctive medications (such as low-dose aspirin when preeclampsia risk is high) can optimize fertility and prevent adverse maternal and neonatal outcomes. Full article

Systemic autoimmune rheumatic diseases (SARDs) in pregnancy represent a complex challenge for both patients and healthcare providers. Timely preparation for pregnancy enables adequate disease control, thereby reducing the risk of disease flare and pregnancy complications. Interdisciplinary care starting from the pre-pregnancy period throughout pregnancy and during breastfeeding ensures better fetal and maternal outcomes. This review provides a comprehensive guide to pre-pregnancy counselling in SARDs, an overview of medication management strategies tailored to pregnancy, disease activity and pregnancy monitoring in patients, and the promotion of shared decision making between healthcare providers and patients. Guidelines from international organizations were selected to provide a basis for this review and guidance through the quintessential discussion points of care. Full article

Background: The fetuses of pregnant women affected by anti-Ro/anti-La antibodies are at risk of developing complete atrioventricular heart block (CAVB) and other potentially life-threatening cardiac affections. CAVB can develop in less than 24 h. Treatment with anti-inflammatory drugs and immunoglobulins (IVIG) can restore the normal rhythm if applied in the transition period. Routine weekly echocardiography, as often recommended, will rarely detect emergent AVB. The surveillance of these pregnancies is controversial. Home-monitoring using a hand-held Doppler is a promising new approach. Methods: To obtain an overview of the current practice in Germany, we developed a web-based survey sent by the DEGUM (German Society of Ultrasound in Medicine) to ultrasound specialists. With the intention to evaluate practicability of home-monitoring, we instructed at-risk pregnant women to use a hand-held Doppler in the vulnerable period between 18 and 26 weeks at our university center. Results: There are trends but no clear consensus on surveillance, prophylaxis, and treatment of anti-Ro/La positive pregnant between specialists in Germany. Currently most experts do not offer home-monitoring but have a positive attitude towards its prospective use. Intensified fetal monitoring using a hand-held Doppler is feasible for pregnant women at risk and does not lead to frequent and unnecessary contact with the center. Conclusion: Evidence-based guidelines are needed to optimize the care of anti-Ro/La-positive pregnant women. Individual risk stratification could help pregnancy care of women at risk and is welcmed by most experts. Hand-held doppler monitoring is accepted by patients and prenatal medicine specialists as an option for intensified monitoring and can be included in an algorithm for surveillance. Full article

The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike. Full article

Antiphospholipid syndrome (APS) is an acquired highly prothrombotic disorder in which thrombo-inflammatory antiphospholipid antibodies (aPL) cause thrombosis via multiple mechanisms, including endothelial damage and activation. Obstetric complications in APS are caused by placental thrombosis, inflammation and complement activation. Anticoagulation is poorly effective in some patients especially those with triple positive aPL who are at ~30% risk of thrombosis recurrence within 10 years. Increasing therapeutic anticoagulation intensity may be beneficial but leads to excess bleeding with serious complications, such as intracerebral haemorrhage. Nonetheless, anticoagulation is still the mainstay of treatment despite the autoimmune nature of APS. The antimalarial immunomodulatory drug hydroxychloroquine (HCQ) has been used for many years for the treatment of inflammatory rheumatic diseases. HCQ has complex pleiotropic mechanisms of action upon multiple cell types. The proposed biological processes that HCQ regulates support the hypothesis that it may be a successful adjunctive treatment in the prevention of recurrent thrombosis and pregnancy complications. Full article