Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospective Italian P-RHEUM.it study

objectives: to investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it. methods: pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 rheumatology centres for 5 years (2018-2023). maternal and infant information were collected in a web-based database. results: we analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. exclusive maternal breast feeding was received by 404 (46.7%) neonates. the edinburgh postnatal depression scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress. conclusions: multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. disease-specific issues need to be further addressed to plan preventative measures.