Evolution of therapy for autoimmune diseases in pregnancy: a retrospective study from 2000 to 2023

Treatment options for rheumatic diseases in pregnancy have consistently changed over the years. The most common therapies for autoimmune diseases during pregnancy include low-dose aspirin (LDA), low-molecular-weight heparin (LMWH), steroids, and hydroxychloroquine (HCQ). Therapy choice is based on obstetrical history, presence of antiphospholipid antibodies, and disease severity and refractoriness. Over the years, we have observed a decrease in glucocorticoid administration and an increase in HCQ administration. Glucocorticoid therapy during pregnancy can increase the risk of premature rupture of membranes and intrauterine growth restriction. In mothers, it is correlated with gestational hypertension, diabetes, osteoporosis, and infections. HCQ appears safe in pregnancy for fetal development and growth; it may improve pregnancy outcomes and reduce the risk of preeclampsia and autoimmune disease flares.

We conducted a retrospective study of 266 pregnant women affected by autoimmune diseases (systemic lupus erythematosus, antiphospholipid syndrome, Sjogren's Syndrome, connective tissue disease) referred to our center from 2000 to 2023.

We observed substantial stability in LDA use, ranging from 100% in 2000-2003 to 96% in 2020-2023 (mean 88%; p 0.54). Regarding LMWH, we observed a modest but consistent increase, starting from 25% in 2000-2003 to 61% in 2020-2023 (mean 50%; p = 0.18). A greater increase was observed in HCQ use, which passed from 13% in 2000-2003 to 40% in 2020-2023 (mean 30%; p 0.62). Lastly, we observed a statistically significant decrease in steroid use, from 50% in 2000-2003 to 13% in 2020-2023 (mean 33%; p < 0.01).

These changes in therapy reflect increased knowledge in autoimmune diseases during pregnancy, with a more consistent number of women able to have and carry a pregnancy despite their disease severity. Over the years, our center had offered the best therapeutic management to achieve a good obstetrical outcome and minimize the incidence of obstetrical complications.