title: Early, Incomplete, or Preclinical Autoimmune Systemic Rheumatic Diseases and Pregnancy Outcome.
abstract: To evaluate the impact of preclinical systemic autoimmune rheumatic disorders on pregnancy outcome.
  
  
  
  In this longitudinal cohort study, patients were enrolled during the first trimester of pregnancy if they reported having had connective tissue disorder symptoms, were found to be positive for circulating autoantibodies, and on clinical evaluation were judged to have a preclinical or incomplete rheumatic disorder. The incidence of fetal growth restriction (FGR), preeclampsia, and adverse pregnancy outcomes in patients with preclinical rheumatic disorders was compared with that in selected controls, after adjustment for confounders by penalized logistic regression. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.
  
  
  
  Of 5,232 women screened, 150 (2.9%) were initially diagnosed as having a suspected rheumatic disorder. After a mean ± SD postpartum follow-up of 16.7 ± 5.5 months, 64 of these women (42.7%) had no clinically apparent rheumatic disease and 86 (57.3%) had persistent symptoms and positive autoantibody results, including 10 (6.7%) who developed a definitive rheumatic disease. The incidences of preeclampsia/FGR and of small for gestational age (SGA) infants were 5.1% (23 of 450) and 9.3% (42 of 450), respectively, among controls, 12.5% (8 of 640) (OR 2.7 [95% CI 1.1-6.4]) and 18.8% (12 of 64) (OR 2.2 [95% CI 1.1-4.5]), respectively, among women with no clinically apparent disease, and 16.3% (14 of 86) (OR 3.8 [95% CI 1.9-7.7]) and 18.6% (16 of 86) (OR 2.3 [95% CI 1.2-4.3]), respectively, among those with persisting symptoms at follow-up. Mean ± SD umbilical artery Doppler pulsatility indices were higher among women with no clinically apparent disease (0.95 ± 0.2) and those with persisting symptoms (0.96 ± 0.21) than in controls (0.89 ± 0.12) (P = 0.01 and P < 0.001, respectively).
  
  
  
  In our study population, preclinical rheumatic disorders were associated with an increased risk of FGR/preeclampsia and SGA. The impact of these findings and their utility in screening for FGR/preeclampsia need to be confirmed in population studies.
authors.affiliation: University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy. spinillo@smatteo.pv.it.
authors.forename: Arsenio
authors.initials: A
authors.lastname: Spinillo
authors.affiliation: University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Fausta
authors.initials: F
authors.lastname: Beneventi
authors.affiliation: University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Locatelli
authors.affiliation: University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Vèronique
authors.initials: V
authors.lastname: Ramoni
authors.affiliation: University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporali
authors.affiliation: University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Alpini
authors.affiliation: University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Albonico
authors.affiliation: University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cavagnoli
authors.affiliation: University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000453:epidemiology / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology; D001327:Autoimmune Diseases / Q000453:epidemiology* / Q000276:immunology; D015331:Cohort Studies; D003240:Connective Tissue Diseases / Q000453:epidemiology / Q000276:immunology; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology / Q000276:immunology; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000276:immunology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011673:Pulsatile Flow; D012216:Rheumatic Diseases / Q000453:epidemiology* / Q000276:immunology; D012859:Sjogren's Syndrome / Q000453:epidemiology / Q000276:immunology; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging
chemical_list: D001323:Autoantibodies