Impact of systemic autoimmune diseases in maternal, fetal and neonatal outcomes in Spain

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ID: 320376
2026
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Abstract
OBJECTIVES: Pregnancy in autoimmune disease is increasingly feasible but carries heterogeneous maternal and perinatal risks beyond hypertensive disorders. We aimed to quantify disease-specific risks of maternal, fetal and neonatal outcomes across autoimmune diseases in a nationwide cohort, explicitly distinguishing primary vs secondary APS. METHODS: We analyzed pregnancy-related hospitalizations in Spain (SNHDD, 2016-2022). Exposures were systemic lupus erythematosus (SLE), primary Sjögren syndrome (SjS), mixed connective tissue disease (MCTD), systemic sclerosis (SSc), sarcoidosis, Behçet disease, and antiphospholipid syndrome (APS) (primary/secondary). Outcomes included preeclampsia (PE), preeclampsia with severe features (PESC), composite maternal morbidity (cesarean delivery, postpartum hemorrhage, thrombosis, stroke, ICU admission), and composite fetal/neonatal morbidity-mortality (fetal distress, fetal growth restriction, preterm delivery, abruptio placentae, stillbirth, neonatal death). RESULTS: In 1,973 249 Spanish pregnancy hospitalizations, 5,727 involved autoimmune disease. Risks clustered by disease: SLE (PE OR 1.78; PESC 2.17; composite maternal 1.35; fetal/neonatal 1.16), primary APS (PE 1.50; PESC 1.88; maternal 1.66; fetal/neonatal 1.10), secondary APS (PE 2.61; PESC 3.47; maternal 1.94), and MCTD (PE 4.57; PESC 7.24) showed the strongest signals. SSc increased composite maternal (1.62) and fetal/neonatal (1.69) risk; SjS raised cesarean and selected fetal outcomes; Behçet disease mainly increased maternal thrombosis (9.31); and sarcoidosis showed no independent associations. CONCLUSIONS: Pregnancies affected by autoimmune disease exhibit distinct, disease-specific patterns of hypertensive, maternal, and fetal/neonatal risk, with the most consistently elevated risks observed in SLE, APS (especially secondary), and MCTD. These comparative estimates may support risk-stratified, guideline-concordant care and inform counseling, surveillance, and delivery planning, with explicit consideration of comorbidity burden.
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Authors Jorge Esteban‐Sampedro, Mario Martín-Portugués, Guillermo Ruiz-Irastorza, Susana Mellor-Pita, P Ureta, Pedro Durán‐del Campo, María Martínez-Urbistondo, Román Fernández-Güitián, Raquel Castejón, Lucía Fuentes-Moreno, F. García Benasach, Alfonso Ortega-de la Puente, Marina de la Cruz-Echeandía, V Ictor Moreno-Torres'
Journal Lara D. Veeken
Year 2026
DOI
10.1093/rheumatology/keag358
URL
https://doi.org/10.1093/rheumatology/keag358
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