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Elective Termination of Pregnancy in Autoimmune Rheumatic Diseases: Experience From Two Databases
Author(s) -
Lockshin Michael D.,
Guerra Marta,
Salmon Jane E.
Publication year - 2020
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41249
Subject(s) - medicine , pregnancy , antiphospholipid syndrome , referral , disease , rheumatic disease , obstetrics , autoimmune disease , pediatrics , surgery , thrombosis , genetics , biology , family medicine
Objective To provide reference data regarding the frequency and safety of elective termination of pregnancy in women with autoimmune rheumatic diseases followed up in 2 referral databases. Methods Two large databases, one from an autoimmune rheumatic disease referral clinical practice with a known interest in pregnancy (the Barbara Volcker Center for Women and Rheumatic Disease [ BVC ]), and one from an observational study of systemic lupus erythematosus– and antiphospholipid antibody–associated pregnancies (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus [ PROMISSE ]), were interrogated for histories of prior elective termination of pregnancy and complications related to incident pregnancy termination. Results Of women who had had prior pregnancies, 21.7% of 1,307 in the BVC database and 25.3% of 297 in the PROMISSE database gave histories of 1–5 prior elective terminations of pregnancy; BVC patients reported no flares or hospitalizable complications due to pregnancy termination. Of 674 incident pregnancies, termination for fetal or maternal reasons was recommended for 15 (2%); of these, 2 fetuses died before the procedure was carried out and 1 woman declined termination and, though gravely ill, successfully delivered. She died of cardiomyopathy 3 years later. Conclusion Many patients with autoimmune rheumatic disease undergo elective termination of pregnancy; few report complications. In medically indicated termination of pregnancy, there are no adverse signals of unusual complications or disease flare.