Pregnancy in autoimmune diseases in the sub-Saharan zone: the experience of the University Hospital of Libreville Department of Internal Medicine.

Autoimmune diseases are a group of heterogeneous conditions responsible for polymorphic clinical and biological manifestations. Because pregnancy activates them and promotes gestational complications, it is difficult for women with these diseases. Pregnancy and autoimmune diseases have rarely been studied in sub-Saharan Africa. We report the experience of the Internal Medicine Department of the University Hospital of Libreville. Conducted retrospectively for 2008 through 2011, and prospectively from 2012 through August 31, 2018, this descriptive and analytical study examined the records at the Department of Internal Medicine of the University Hospital Center of Libreville of women with a known autoimmune disease, receiving regular care there, and who became pregnant after the diagnosis. During pregnancy, women were monitored and manÂged simultaneously in the departments of obstetrics and internal medicine. Data considered for this study were demographic data (Âge, sex, social status), type of autoimmune disease, including the diagnosis, the therapies used, extent of disease control, and time from diagnosis to each pregnancy. Obstetric data include the number of fetuses, obstetric complications, gestational Âge at and route of delivery, fetal sex, and Apgar score to 5 minutes (normal ≥ 7). Women had the following autoimmune diseases : systemic lupus erythematosus (SLE) (n = 16), Sjögren's disease (n = 3), inflammatory myopathy (n = 2), rheumatoid arthritis (n = 1), primary antiphospholipid syndrome (APS) (n = 1), and Still disease (n = 1).The overall averÂge Âge at diagnosis was 26.6 years (range : 13-40). The 24 women had 32 pregnancies. The mean interval from diagnosis to first pregnancy was 3.3 years, to the second pregnancy also 3.3 years (n = 6), and to the third (n = 2), 5 years. Disease was controlled for at least 2 years (n = 23) except for one woman with primary APS. Therapeutically, corticosteroids were used alone (n = 2) or combined with other immunomodulatory therapies (n = 32). Gestational complications included spontaneous abortions in the first trimester (n =2), in utero deaths (n = 2), perinatal death on day 12 (n = 1), and eclampsia (n = 2), one of which was complicated by a pulmonary embolism in the first pregnancy. The mean gestational Âge at delivery was 37 weeks. Intrauterine growth restriction affected 11 fetuses, and preterm delivery 18. There were 11 cesarean deliveries and 16 vaginal. Mean birth weight was 2353.3 grams, Apgar was ≥ 7 for all neonates except in one case of dermatomyositis complicating a neonatal death. The sex ratio was 13 male infants per 17 females. Women with optimal disease control can become pregnant and have positive pregnancy outcomes. This possibility has been little explored in sub-Saharan Africa; mystical-religious notions of conceptions persist and can prevent women from attempting to become prégnant . This experience with a short series of viable fetuses of women with autoimmune diseases is therefore encouraging and deserves to be continued.