Ab1478 Pregnancy Outcomes From a Tertiary Obstetric Rheumatology Clinic in the United Kingdom: A 10-Year Retrospective Audit

Background: Inflammatory rheumatic and musculoskeletal diseases (iRMDs) have a predilection for women of childbearing age. Active disease increases the risk of adverse pregnancy outcomes, whilst passage of Ro antibodies may lead to congenital heart block (CHB). Pregnancy may be poorly tolerated by women with established organ damage and counselling is complicated by the limited evidence available to guide prescribing. The Obstetric Rheumatology clinic was established at University College London Hospital (UCLH) in 2007 to provide pre-pregnancy, pregnancy and post-partum care for women with iRMDs. Our local catchment area is ethnically diverse and UCLH itself delivers a range of highly specialist services resulting in referrals from across the United Kingdom. The UCLH Obstetric unit also acts as the central site for the North Central London Maternal Medicine Network. Objectives: To describe pregnancy outcomes in patients attending the Obstetric Rheumatology clinic at UCLH. Methods: We conducted a retrospective review of pregnancy outcomes for all patients attending the clinic between January 2013-May 2023. Selected information was extracted from the electronic patient record and inputted to Excel. A single encounter was recorded for each patient within the database for each pregnancy. For patients attending for pre-pregnancy counselling (PPC) – the appointment was coded as part of the pregnancy encounter if they subsequently conceived within 2 years of PPC or separately if no conception took place within this time or prior to the end of data collection for those seen late 2021 onwards. Results: Mean age was 32.9 years old (range 17—52 years old). 55.2% were white, 10.1% black, 15% Asian, 4.6% of mixed heritage, 9.8% listed as other, and ethnicity undocumented in 5.3%. Accounting for some patients having more than one iRMD, diseases included 176 rheumatoid arthritis, 167 systemic lupus erythematosus, 126 juvenile inflammatory arthritis, 61 inflammatory spondyloarthritis, 57 Sjogren's syndrome, 44 seronegative arthritis, 40 undifferentiated connective tissue disease, 42 psoriatic arthritis, 14 vasculitis, 15 inflammatory myositis, 12 adult onset still's disease, 9 scleroderma and 112 miscellaneous conditions including hypermobility and fibromyalgia. 852 unique pregnancy or pre-pregnancy encounters were recorded in 753 women. 185 of these encounters were for PPC only. Of the 667 encounters with a current or subsequent pregnancy within 2 years (or within the period of data collection ending for those seen after 2021) there were 600 encounters resulting in livebirth (587 singleton infants, 13 sets of twins of whom 25 were liveborn), 4 stillbirths (1 of whom was a twin), 34 miscarriages, 1 ectopic pregnancy and 4 terminations. In 5 the pregnancy is ongoing at the time of writing. In 20 the pregnancy outcome is unknown. Not all pregnancies had complete outcome data. Among the 612 live borns, there were 3 neonatal deaths (including 1 twin) and 8 congenital defects. Among 600 encounters resulting in livebirths – 282 delivered via c-section, 268 delivered vaginally, and in 50 it wasn't recorded. Among 603 encounters resulting in livebirths and/or stillbirths, 12 were recorded as having gestational hypertension, 22 pre-eclampsia, 58 gestational diabetes and 10 obstetric cholestasis. 103 of these encounters were in women known to be anti-Ro positive (including 4 women with twins); 2 cases of CHB occurred (ratio 1:51.5). Both CHB cases were born to mothers with previously affected infants; 1 of the mothers could not take hydroxychloroquine due to retinopathy. Of singleton livebirths with sufficient documentation to calculate, 109/468 (23.3%) were small for gestational age (SGA; birthweight below 10th centile; rate in general UCLH population 15%), and 56/508 (11%) were born pre-term (Conclusion: We report the longest and largest Obstetric Rheumatology clinic experience in the literature to date. Multidisciplinary specialist care of women with iRMD achieves good pregnancy outcomes but with an ongoing risk of CHB, SGA and prematurity. REFERENCES: NIL. Acknowledgements: Dr Bethan Goulden and Dr George Woodward contributed equally to this abstract and are co-main authors on this study. Disclosure of Interests: Bethan Goulden: None declared, George Woodward: None declared, Siddharth Jain: None declared, Sophie Leiner: None declared, Trini Mitra: None declared, Hanh Nguyen: None declared, Diane Nzelu: None declared, David Williams: None declared, Ian Giles Speaker fees for UCB, honoraria as a co-author on an educational review article in 2020 for MGP, Payment for advisory board for UCB (manufacturer of cimzia), Unrestricted research grant for clinical PhD fellowship.