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Pregnancy Updates That Will Change The Way I Practice
ACR Convergence is truly drinking from the proverbial fire hose. It’s a beautiful mash-up of basic science and treatment updates meets guidelines, recommendations, and disease identification.
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English for the Biologically-Challenged (8.4.2023)
Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com. This week highlights Veterans, Vegetarians and Antenatal Corticosteroids.
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SLE and Pregnancy Outcomes
Obstetric complications and poor pregnancy outcomes are not uncommon in women with SLE, especially with active disease. A large Spanish cohort trials shows that term pregnancy is more likely before the diagnosis of SLE and that poorer pregnancy outcomes were associated with antibody positivity to anticardiolipin IgG and anti-beta-2- glycoprotein IgG/IgM, but not lupus anticoagulant.
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ICYMI: 25 Great Women in Rheumatology
I reached out to many leaders in rheumatology and asked: who are the great women in rheumatology who should be recognized? This was prompted by a smart article in Annals of Rheumatic Disease written by Drs. Tuhina Neogi (Boston) and Nicola Dalbeth (N. Zealand), entitled "Where are the women ‘Heroes and Pillars of Rheumatology’?
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Should all of active moms with #SLE receive DVT prophylaxis post partum? High rates of VTE in #ARDs post partum #0722 #ACRbest #ACR23 @RheumNow @ACRheum Likely data driven by #SLE and maybe #RA and not all #autoimmune #rheumatic #disease. Large pop’n data from California https://t.co/sGJa5N6HUj
Janet Pope ( View Tweet)
Plenary talk by Dhital etc al, shows increased risk of acute CV events in pregnant rheumatic, SLE, APS pts, esp if nephritis or APL+. #ACR23 Abstract 0722 https://t.co/pG0PqzVtIU
Dr. John Cush RheumNow ( View Tweet)
Analysis from the DESIR cohort reveal that pregnancy does not aggravate imaging changes in axSpA.
Stat significant changes seen on Xray of LSIJ b4 & after delivery (p=0.037) but not worsening.
Do these findings also translate to⬇️pain/improved QOL?
#ACR23 ABST0513 @RheumNow https://t.co/s6xD2CaPwn
sheila ( View Tweet)
Does pregnancy affect axSpA imaging?
Large study of 381 pts, in the DESIR cohort, f/up of 5 years.
Pregnancy did not aggravate imaging of axSpA women compared to prior to pregnancy.
@RheumNow #ACR23 Abs#0513 https://t.co/eeGuxGGB5E
Robert B Chao, MD ( View Tweet)
#ACR23 Abs 0465 suggests changes in rheums’ rx patterns in context of nationwide abortion restriction, particularly in abortion-restricted states; reproductive-age female pts may have less access to EB treatments like MTX/MMF for rheum dz. https://t.co/QN9C4PjUaN
@rheumnow
Dr. Rachel Tate ( View Tweet)
We gotta do better! Reproductive health counseling is poorly done- only a third rheumatologists surveyed ask pts about reproductive health: sexual activity, pregnancy desire, contraception. Abstr#0162 @_michgarcia @rheumnow #ACR23 https://t.co/r9tewu2I9N
TheDaoIndex KDAO2011 ( View Tweet)
DESIR cohort update in Abs #0513 shows axSpA pt imaging doesn't "worsen" after pregnancy. However, following 1st pregnancy, can see slight increase in L SIJ score, but typically not enough to define "worsening." #ACR23 https://t.co/HaYj3RQGFb @rheumnow https://t.co/5MQCXS1Kat
Dr. Rachel Tate ( View Tweet)
Pregnancy is complicated for women with rheumatic diseases.
There's a pathway to healthy mothers & babies, but it takes:
- planning
- the right meds
- the right disease control.
@drbags71 #ACR23 Review Course @RheumNow https://t.co/epdDIVGPye
David Liew drdavidliew ( View Tweet)
@drbags71 @RheumNow Too often we don't leave women of childbearing age with a plan, if they do get pregnant. And we need to help them get ready, for whatever they want, so we can avoid bad outcomes - and all the consequences of that.
@drbags71 #ACR23 Review COurse @RheumNow https://t.co/HLg6KjCiJX
David Liew drdavidliew ( View Tweet)
@drbags71 @RheumNow So approach @drbags71:
HOP-STEP
- proactively ask/communicate
- make difficult discussions easier with these truly amazing guides:
https://t.co/9AJIrF9bsQ counselling
https://t.co/618mrifi3f dr/pt Rx plans
⬆️**bookmark these**
- share
do not miss!
#ACR23 Review Course @RheumNow https://t.co/vWwJLu2HWG
David Liew drdavidliew ( View Tweet)
"Reproductive right is a global issue"- @CuoghiE suggests what Rheums can do:
👉Advocate for legislation to help pts
👉Integrate family planning
👉Prescribe emergency contraception
👉Provide education about reproductive health
#GlobalSummit @ACRheum @RheumNow https://t.co/jLHpzJT2wf
TheDaoIndex KDAO2011 ( View Tweet)
Dr. del Carmen Zamora-Medina listed several reasons why rheum patients may seek #abortion: teratogenic meds, comorbidities, high disease activity, increased APOs, &women focused reasons. #ACR23 @GlobalSummit #ReproductiveRights @Rheumnow https://t.co/CaH9GVfVvY
TheDaoIndex KDAO2011 ( View Tweet)
342 systemic sclerosis pts, ~32% report reproductive probs:
-early menopause onset (45 vs 48y)
-menopause effected by SSc onset & digital ulcers
-More spont Abs(12 vs 4%), premies (22 vs 6%), low birth Wt (27 vs 5%), C-section (49 vs 19%); NOT Infertility https://t.co/Tjjl9sxtja https://t.co/LKzyGR0mlE
Dr. John Cush RheumNow ( View Tweet)
SLE and Pregnancy Outcomes
Obstetric complications and poor pregnancy outcomes are not uncommon in women with systemic lupus erythematosus (SLE), especially with active disease.
https://t.co/ojFccY6kTT https://t.co/kJpIZP1kSd
Links:
Dr. John Cush RheumNow ( View Tweet)
SLE and Pregnancy Outcomes
Obstetric complications and poor pregnancy outcomes are not uncommon in women with systemic lupus erythematosus (SLE), especially with active disease.
https://t.co/BeCQYTq928 https://t.co/M6oILWfah1
Links:
Dr. John Cush RheumNow ( View Tweet)
Swedish registry study shows of 3629 children born to mothers with RA#, 70 (1.94%) were diagnosed with Autism Spectrum disorder (ASD). If RA was dx before delivery, an increased risk of ASD (HR = 1.43), especially for seronegative RA (HR = 1.61) https://t.co/6OVZhkTdGc https://t.co/3VHhI7nfQm
Links:
Dr. John Cush RheumNow ( View Tweet)
