title: Prevalence and significance of previously undiagnosed rheumatic diseases in pregnancy.
abstract: OBJECTIVE
  The objective of this study was to evaluate the rates of previously undiagnosed rheumatic diseases during the first trimester of pregnancy and their impact on the pregnancy outcome.
  
  
  METHODS
  Pregnant women in their first trimester were screened using a two-step approach using a self-administered 10-item questionnaire and subsequent testing for rheumatic autoantibodies (antinuclear antibody, anti-double-stranded DNA, anti-extractable nuclear antigen, anticardiolipin antibodies, anti-β2-glycoprotein I antibodies and lupus anticoagulant) and evaluation by a rheumatologist. Overall, the complications of pregnancy evaluated included fetal loss, pre-eclampsia, gestational diabetes, fetal growth restriction, delivery at less than 34 weeks, neonatal resuscitation and admission to the neonatal intensive care unit.
  
  
  RESULTS
  Out of the 2458 women screened, the authors identified 62 (2.5%) women with previously undiagnosed undifferentiated connective tissue disease (UCTD) and 24 (0.98%) women with previously undiagnosed definite systemic rheumatic disease. The prevalences were seven (0.28%) for systemic lupus erythematosus and Sjogren's syndrome, six (0.24%) for rheumatoid arthritis, three (0.12%) for antiphospholipid syndrome and one (0.04%) for systemic sclerosis. In multiple exact logistic regression, after adjustment for potential confounders, the OR of overall complications of pregnancy were 2.81 (95% CI 1.29 to 6.18) in women with UCTD and 4.57 (95% CI 1.57 to 13.57) in those with definite diseases, respectively, compared with asymptomatic controls.
  
  
  CONCLUSIONS
  In our population approximately 2.5% and 1% of first trimester pregnant women had a previously undiagnosed UCTD and definite systemic rheumatic disease, respectively. These conditions were associated with significant negative effects on the outcome of pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Arsenio
authors.initials: A
authors.lastname: Spinillo
authors.forename: Fausta
authors.initials: F
authors.lastname: Beneventi
authors.forename: Véronique
authors.initials: V
authors.lastname: Ramoni
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporali
authors.forename: Elena
authors.initials: E
authors.lastname: Locatelli
authors.forename: Margherita
authors.initials: M
authors.lastname: Simonetta
authors.forename: Chiara
authors.initials: C
authors.lastname: Cavagnoli
authors.forename: Claudia
authors.initials: C
authors.lastname: Alpini
authors.forename: Giulia
authors.initials: G
authors.lastname: Albonico
authors.forename: Elena
authors.initials: E
authors.lastname: Prisco
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000175:diagnosis / Q000453:epidemiology; D003240:Connective Tissue Diseases / Q000175:diagnosis / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005317:Fetal Growth Retardation / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000379:methods; D010865:Pilot Projects; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D015995:Prevalence; D012216:Rheumatic Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology; D011795:Surveys and Questionnaires