Undifferentiated connective tissue diseases and adverse pregnancy outcomes. An undervalued association?

Am J Reprod Immunol. 2017 Dec;78(6). doi: 10.1111/aji.12762. Epub 2017 Sep 16.

Abstract

Undifferentiated connective tissue diseases (UCTDs) are a heterogeneous group of disorders characterized by symptoms and signs suggestive of systemic autoimmune rheumatic disease (ARD), but which do not fulfill all the established criteria for definite diagnosis of a condition. Although a third of UCTDs can progress to a definite ARD within months or years, most UCTDs can remain stable for years with minimal disease activity. The annual incidence of UCTD in the general population ranges from 14 to 140 per 100 000 people. UCTDs are associated with the persistence of several circulating autoantibodies including antinuclear, antiphospholipid or antithyroid antibodies. Immunological evaluation of subjects with UCTDs suggests a proinflammatory state and dysregulation of the Th1/Th2 balance. Autoantibodies have well-known deleterious effects on placentation and have been associated with an increased risk of prematurity, fetal growth restriction (FGR), preeclampsia, and congenital atrioventricular heart block. Although epidemiological and biological data suggest a potential negative impact on reproductive outcomes, the relationship between UCTD and pregnancy outcomes has not been adequately studied. While awaiting definitive data from large studies, obstetricians should be aware that rheumatic disorders in their early, incomplete, or undifferentiated phases can adversely affect pregnancy outcomes, increasing the likelihood of pregnancy loss, FGR, preeclampsia, and prematurity.

Keywords: autoimmune systemic diseases; fetal growth restriction; pregnancy; prematurity; rheumatic diseases; undifferentiated connective tissue diseases.

Publication types

  • Review

MeSH terms

  • Adult
  • Animals
  • Autoantibodies / metabolism
  • Autoimmune Diseases / epidemiology*
  • Female
  • Fetal Growth Retardation / epidemiology*
  • Humans
  • Incidence
  • Pre-Eclampsia / epidemiology*
  • Pregnancy
  • Pregnancy Outcome
  • Rheumatic Diseases / epidemiology*
  • Risk
  • Th1-Th2 Balance
  • Undifferentiated Connective Tissue Diseases / epidemiology*

Substances

  • Autoantibodies