Beyond pregnancy in systemic autoimmune diseases: a focus on postpartum experience from a referral centre.

Abstract

To evaluate the incidence and types of complications occurring within 60 days postpartum in patients with systemic autoimmune diseases (SAD), focusing on disease flares and other clinical events. This is a retrospective analysis of prospectively collected data from a single-centre cohort. Variables included demographic and clinical features, pregnancy treatments, disease course, postpartum visit attendance, complications and breastfeeding data. A total of 253 pregnancies were included. Most diagnoses were connective tissue diseases (CTDs, 80.2%), followed by inflammatory arthritis (14.2%) and vasculitis (5.5%). A postpartum visit was performed in 234 patients (92.5%). Postpartum complications occurred in 50 patients (19.8%), including 42 flares (16.6%) and 12 other complications (4.7%). Flares included 20 articular, five mucocutaneous, five renal, four hematological, three parotid swelling, two deep venous thromboses in aPL-positive patients, two uveitis relapses and one myositis. Flares were associated with active disease during pregnancy (P < 0.01). Inflammatory arthritis showed the highest flare rate (41.7% vs 12.0% in CTD, P < 0.01), though severe flares occurred only in CTD or vasculitis. Other complications included six hypertension cases, four postpartum hemorrhages (two on LDA/LMWH), one Clostridium difficile infection and one ICU admission for severe hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Non-flare complications did not differ by diagnosis. At postpartum visit, 147 patients (58.5%) were breastfeeding. Of the 42 with flares, four were contraindicated to breastfeed due to therapies. The others who did not breastfeed did so by choice or unrelated reasons. The postpartum period is high-risk in SAD patients. Follow-up should extend beyond pregnancy, with multidisciplinary care to manage disease activity and breastfeeding-related treatment restrictions.