Outcomes And Influencing Factors Of 126 Pregnancy Patients With Undifferentiated Connective Tissue Disease:A Real-world Prospective Study

Objective:Undifferentiated connective tissue disease(UCTD)patients have various clinical manifestations and tend to relapse during pregnancy.To analyze the factors influencing pregnancy outcomes,we observe the clinical characteristics of pregnant patients with UCTD and fetal abnormalities events,to compare the disease activity,different treatment between adverse pregnancy outcomes(APO)and normal pregnancy outcomes(NAPO).Methods:A total of 126 pregnancies of 124 patients with UCTD were enrolled from September 2018 to October 2021.They were divided into different groups according to with or without antiphospholipid antibodies(aPL),that was the non-aPL group and aPL group.Also they were grouped according to the outcomes of pregnancy(APO and NAPO group),and whether having failed pregnancy outcomes or not(failure pregnancy group and successful pregnancy group).According to whether the patients in the successful pregnancy group delivered prematurely or had low birth weight infants,they were further grouped and compared.The clinical characteristics and treatment of each subgroup were analyzed,and the differences in pregnancy outcomes were compared.Results:The incidence of fetal Doppler ultrasound abnormalities events(AE)and APO was different in patients with different antibodies during pregnancy.In the previous pregnancy outcomes,failed pregnancies(especially the unexplained spontaneous abortion within 10 weeks,p=0.033)were more common in the aPL group(p=0.048).The incidence of low complement C3 in the third trimester was higher in the non-aPL group than in the aPL group(p=0.028).More potent anticoagulation regimens were used in the aPL group.The usage of LDA combined with LMWH in the aPL group was significantly higher than that in the non-aPL group in the first,second and third trimesters(p<0.001,p=0.005,p<0.001,respectively).In the non-aPL group,the usage of LDA in patients without fetal AEs during pregnancy was higher than those with fetal AEs(p=0.008),but the incidence of APO in the former group was significantly lower than that in the latter(p=0.019).In the aPL group,the average dosage of GC and the usage of IVIG in patients with fetal AEs were higher than patients without fetal AEs(p<0.001,p=0.039,respectively),but there was no significant difference in pregnancy outcomes between the two groups.In the APO group,the incidence of late fetal loss(≥10 weeks)in the past was 34.4%(11/32),compared with 12.8%(12/94)in the NAPO group(p=0.006),and the percentage of positive aβ2GPI-IgG in the APO group significantly higher than that in the NAPO group(p=0.028),and the incidence of thrombocytopenia in the APO group was also significantly higher than that in the NAPO group(18.8%vs.4.3%,p=0.025).The average dosage of GC in APO group(10.37 ±5.08mg/d)was higher than that in NAPO(7.35±4.45mg/d)(p=0.006).The gestational age of the APO group(26.49 ± 11.17 weeks)was significantly shorter than that of the NAPO group(38.58±0.97 weeks).Multivariate regression analysis confirmed that previous late fetal loss,positive aβ2GPI-IgG and thrombocytopenia were risk factors for the occurrence of this APO.Conclusion:UCTD patients,whether with aPLs or not,had high risk pregnancy and the live birth rate was around 90%.Patients with positive aPL had more adverse pregnancy events in the past,and more anticoagulation therapy was used in this pregnancy,but the incidence of APO did not increase significantly.The influencing factors of APO included the history of late fetal loss,positive aβ2GPI-IgG and maternal thrombocytopenia.The appropriate dosage and chance to use GC in pregnancy of UCTD patients need more research in detail.