PO:12:187 | Maternal Hypertensive Disorders in Pregnant Women with Rheumatic Diseases and long-term Cardiovascular Outcomes: preliminary data of a single centre experience

Margherita Rinaldi¹, Paolo Semeraro¹, Francesca Crisafulli¹, Matteo Filippini², Maria Grazia Lazzaroni¹, Cecilia Nalli¹, Liala Moschetti¹, Marco Taglietti², Chiara Loardi³, Rossana Orabona³, Francesca Ramazzotto³, Sonia Zatti³, Laura Andreoli¹, Angela Tincani¹, Micaela Fredi¹, Ilaria Cavazzana¹, Franco Franceschini¹ | ¹Department of Clinical and Experimental Sciences, University of Brescia, Italy; ²Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia, ERN-ReCONNET Center Brescia, Italy; ³Gynaecology and Obstetrics Unit ASST Spedali Civili di Brescia, Italy

Introduction. Pregnancies in patients affected by rheumatic diseases (RD) carry a higher risk of developing gestational hypertensive disorders (GHD) and subsequently chronic cardiovascular disorders (CVD). There is little to no literature on this topic and is mainly focused on Systemic Lupus Erythematosus (SLE). Since systemic autoimmune diseases are associated with an increased CVD risk, it is particularly relevant to investigate how this risk may be further amplified in the presence of a history of GHD; hence the aim of this study was to analyse the incidence and type of CVD in RD patients who experienced a GHD.

Methods. A monocentric retrospective observational study was conducted, prospectively analysing the medical records of RD patients followed from 1985 to 2025 who had a pregnancy complicated by GHD. Inclusion criteria required past medical history of GHD and a diagnosis of RD and a follow-up of at least of 5 years. The following CV events were included: major CV disorders, chronic hypertension, evidence at imaging of CV events. The CV outcome was evaluated in pts with a post-partum follow-up of >/= 5 years.

Results. The cohort includes 41 patients, mainly of Caucasian ethnicity (36; 87.8%), with age at follow up ranging from 31 to 64 (average 45 years), each affected by a rheumatic disease, the most represented being Antiphospholipid Syndrome (APS) (18; 49.9%) and Systemic Lupus erythematosus (12; 29.3%). All patients had an obstetric history of GHD, preeclampsia being the most common (17; 41.5%,) followed by HELLP syndrome (9; 22%) (Table 1). Risk factors for CVD were considered and CVD outcome were analysed (Table 2): 51.2% patients developed at least 1 cardiovascular disorder, the most experienced one was chronic HTN (19/21 pts). 6 patients (14.6%) developed more than 1 CVD. 8/21 CVD events occurred within the first 5 years from gestational hypertensive event, 5 occurred between 5 and 10 years, 2 occurred later than 10 years and for 6 patients the time of onset of CVD was unknown.

Conclusions. Despite the improvement in the last decades thanks to multidisciplinary management and the recognition of risk factors, RD pts have worse gestational outcomes than general population. Though the monocentric study design included a relatively small number of pts, in our cohort we noticed a not negligible onset of chronic arterial hypertension. These results highlight the need for both immediate and long-term cardiovascular surveillance in this vulnerable population. Early recognition and proactive management of CV risk are therefore essential in RD patients with a history of GHD.

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