P83 A pre-pregnancy counselling pathway for women with systemic lupus erythematosus and/or antiphospholipid syndrome: the effect on maternal and fetal pregnancy complications and the course of disease – a retrospective cohort study. (23rd March 2020) - Wind, Merlijn
Abstract : Background: Women with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) are at higher risk of complications and SLE flares during pregnancy and are therefore referred to as 'high risk pregnancies'. To provide optimal patient care, a multidisciplinary pre-pregnancy counselling approach is recommended. We examined the effect of such a multidisciplinary pre-pregnancy counselling pathway that is specifically designed for SLE and/or APS patients on the maternal and fetal pregnancy complications and on the course of SLE and APS disease. Methods: We performed a retrospective cohort study on records in the Leiden University Medical Center (LUMC), a tertiary referral hospital in the Netherlands. We compared a cohort of SLE and/or APS pregnancies enrolled in the pre-pregnancy counselling pathway (2014–2018) with a historical cohort of SLE and/or APS pregnancies that were not enrolled in the pathway (2008–2014). Results: This study was done on 34 pregnancies in the pathway cohort and 71 in the cohort. The pathway cohort had more severe SLE disease than the historical cohort. SLE flares developed in 18 (32%) of all SLE pregnancies, whereas the risk on a flare was significantly (p=0.042) lower in the pathway cohort (n=1, 8%) than in historical cohort (n=17, 40%). The incidence of maternal and fetal pregnancy complications were not different between the pathway and the historical cohort. Conclusions: This study showed the positive effect of a multidisciplinary pathway for SLE and/or APS patients on a significant reduction in SLE flares. Although, overall, the patients that were enrolled in the pathway suffered from more severe SLE disease than the historical cohort, the incidence of maternal and fetal complications were similar in both groups. We believe that, women with SLE and/or APS would benefit from pre-pregnancy referral to a hospital with a multidisciplinary approach towards pre-pregnancy counselling and pregnancy follow up.