Certain Preclinical Autoimmune Diseases Elevate Adverse Pregnancy Outcome Risk

Researchers reviewed the available evidence on adverse pregnancy outcomes in patients who were subsequently diagnosed with rheumatic diseases to identify risk.

Pregnant women with certain preclinical autoimmune rheumatic diseases (preARDs) experience adverse pregnancy outcomes (APOs) more than pregnant women in the general population, according to findings published in Rheumatology (Oxford).

Researchers conducted a systematic literature review on PubMed from inception until June 2021 to assess whether APOs correlated with preclinical ARDs. They identified 176 relevant studies and included 27 studies in their review.

The APOs comprised pre-eclampsia, new onset hypertension, hemolysis elevated liver enzymes and low platelet count (HELLP) syndrome, recurrent first trimester pregnancy loss, spontaneous abortion, stillbirth, intrauterine growth restriction, preterm birth, and low birth weight.

The 27 studies reported APOs in women with preARDs, such as rheumatoid arthritis (preRA), systemic lupus erythematosus (preSLE), systemic sclerosis (preSSc), Sjögren syndrome (preSS), psoriatic arthritis, juvenile idiopathic arthritis, Inflammatory Polyarthritis, and ankylosing spondylitis.

Most studies analyzed preRA and preSLE, which led the investigators to subdivide their systematic review analysis into 3 groups: over 1000 pregnancies in women with preSLE, over 1600 pregnancies in women with preRA, and over 900 pregnancies in women with other preARDs. All but 2 studies compared APOs in women with preARDs to outcomes in women in the general population or women with clinically diagnosed ARDs.

Women with preSLE experienced increased APO incidence compared with women in the general population; however, they experienced fewer APOs compared with women clinically diagnosed with SLE.

In contrast to women with preSLE, women with preRA experienced APOs at similar rates to the general population and to women already diagnosed with RA.

In the third subgroup of other preARDs, the most notable findings showed that women with preSSc experienced APOs more than the general population, and that preSSc correlated with increased risk for spontaneous abortion.

Limitations of the analysis include study heterogeneity, retrospective design resulting in incomplete data, small sample sizes, the use of self-reported surveys, and overlooking the impact of singleton versus multiple pregnancy on outcomes, especially preterm birth. These factors affected overall quality of the studies, limiting applicability of conclusions due to low quality evidence.

The study authors conclude, “Our findings of an increased risk for APOs in certain preARDs highlights the relevance of an obstetric history during the first rheumatology appointment and the need for novel screening strategies to predict APOs.”


Muñoz CM, Goulden B, Ahmed K, Alijotas-Reig J, Giles I. Risk of APOS prior to the onset of an autoimmune rheumatic disease: a systematic review. Rheumatology (Oxford). Published online August 5, 2022:keac417. doi:10.1093/rheumatology/keac417