ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Evolution of therapy for autoimmune diseases in pregnancy: a retrospective study from 2000 to 2023
Cristina Garufi 1
Francesca Rizzo 2
Viviana Matys 3
Ester Garufi 4
Angela Botta 2
Valerio Andreozzi 5
Silvia Salvi 2
Tullio Ghi 2
Sara De Carolis 2
1. Universita degli Studi di Roma La Sapienza Dipartimento di Scienze Cliniche Internistiche Anestesiologiche e Cardiovascolari, Rome, Italy
2. Department of Obstetrics, Gynecology and Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
3. Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
4. Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy
5. Department of Orthopaedics, Sapienza University of Rome, Rome, Italy
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Introduction. Treatment options for rheumatic diseases in pregnancy have consistently changed over the years. The most common therapies for autoimmune diseases during pregnancy include low-dose aspirin (LDA), low-molecular-weight heparin (LMWH), steroids, and hydroxychloroquine (HCQ). Therapy choice is based on obstetrical history, presence of antiphospholipid antibodies, and disease severity and refractoriness. Over the years, we have observed a decrease in glucocorticoid administration and an increase in HCQ administration. Glucocorticoid therapy during pregnancy can increase the risk of premature rupture of membranes and intrauterine growth restriction. In mothers, it is correlated with gestational hypertension, diabetes, osteoporosis, and infections. HCQ appears safe in pregnancy for fetal development and growth; it may improve pregnancy outcomes and reduce the risk of preeclampsia and autoimmune disease flares. Methods. We conducted a retrospective study of 266 pregnant women affected by autoimmune diseases (Systemic Lupus Erythematosus, Antiphospholipid Syndrome, Sjogren's Syndrome, Connective Tissue Disease) referred to our centre from 2000 to 2023. Results. We observed substantial stability in LDA use, ranging from 100% in 2000-2003 to 96% in 2020-2023 (mean 88%; p 0.54). Regarding LMWH, we observed a modest but consistent increase, starting from 25% in 2000-2003 to 61% in 2020-2023 (mean 50%; p = 0.18). A greater increase was observed in HCQ use, which passed from 13% in 2000-2003 to 40% in 2020-2023 (mean 30%; p 0.62). Lastly, we observed a statistically significant decrease in steroid use, from 50% in 2000-2003 to 13% in 2020-2023 (mean 33%; p <0.01). Conclusions. These changes in therapy reflect increased knowledge in autoimmune diseases during pregnancy, with a more consistent number of women able to have and carry a pregnancy despite their disease severity. Over the years, our center had offered the best therapeutic management to achieve a good obstetrical outcome and minimize the incidence of obstetrical complications.
Summary
Keywords
Autoimmune Diseases, corticosteroids, Hydroxychloroquine, low-doseaspirin, low-molecular-weight heparin, Pregnancy
Received
30 September 2025
Accepted
26 January 2026
Copyright
© 2026 Garufi, Rizzo, Matys, Garufi, Botta, Andreozzi, Salvi, Ghi and De Carolis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Viviana Matys
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.