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Vol. 18. Issue 9.
Pages 561-563 (November 2022)
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Vol. 18. Issue 9.
Pages 561-563 (November 2022)
Letter to the Editor
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Outcomes of Pregnancy in Women With Idiopathic Inflammatory Myopathies in Africa
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Mickael Essoumaa,b,
Corresponding author
essmic@rocketmail.com

Corresponding author.
, Jean Jacques Noubiapc
a Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
b Network of Immunity in Infections, Autoimmunity and Malignancy (NIIMA), Universal Scientific Education and Research Network (USERN), Yaoundé, Cameroon
c Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Dear Editor,

Idiopathic inflammatory myopathies (IIMs) are associated with adverse pregnancy outcomes in Caucasian and Asian populations,1,2 but this issue is unclear in Africa. For the purpose of this paper, we conducted a systematic review of the literature to identify studies on IIMs and pregnancy in Africa from electronic and hand searches up to March 4, 2021, using key search terms referring to IIMs, pregnancy and African countries as per the United Nations Classification.3

Of 118 records retrieved from PubMed, Embase, Africa Journals Online and hand searches, we included 4 relevant case reports and 2 case-series4–9 from Gabon, Mali, Morocco, Senegal and Tunisia. The search strategy in PubMed and Embase as well as the study selection process are summarized in the Supplementary Table and the Supplementary Figure. Included records report a total of 18 singleton post-IIM pregnancies and 10 singleton pre-IIM pregnancies in 12 women aged 26–42 years at conception. Among women with ethnicity data, 6 were Black Africans, 1 Black Caribbean and 1 North African. Specified IIM subtypes were overlap myositis (n=4), dermatomyositis (n=4) and immune-mediated necrotizing myopathy (n=2). Regarding pre-IIM pregnancies, there were only 2 adverse pregnancy outcomes: medical termination of a pregnancy (for unspecifed cause) and one stillbirth. In women with post-IIM pregnancy data, 8 of 18 pregnancies were successful. Adverse maternal outcomes recorded in post-IIM pregnancies were premature delivery (n=4), cesarean section (n=3), medical termination for unspecified causes (n=3) and pulmonary infection (n=1). Adverse fetal/neonatal outcomes were pre-term birth (n=4), neonatal death (n=2), small for gestational age (n=2), stillbirth (n=1) and neonatal lupus (n=1) (Table 1).

Table 1.

Characteristics and outcomes of pregnancy in women with idiopathic inflammatory myopathies in Africa.

Study  Period of recruitment  Country  Patient number  Ethnicity/race  Age, years  Number of pre-IIM pregnancy(ies)  Outcomes of pre-IIM pregnancy  Year of diagnosis of IIM  Subtype of IIM  Post-IIM pregnancyTreatment before pregnancy  Disease activity at conception and throughout pregnancy  treatment of IIMs through pregnancy  Outcomes of post-IIM pregnancy  Post-partum outcome of IIMs 
                    Number  Year           
Iba-Ba, 2009 [4]  2004-2005  Gabon  Black African  30  –  2004  Myositis overlaping with SLE  2005  -GCs-AM  Inactive  None  -Premature delivery-Cesarean section at 32 weeks, due to pneumonia-Neonatal death at day 12 of life  NR 
Kaddour, 2009 [5]1979–2007Tunisia2NR21  01993Myositis overlaping with RA–  –  –  –  –   
27  1999  GCs  Inactive  GCs  Successful  NR 
28  2000  -GCs-MTX  Inactive  -GCs-MTX  Medical termination for unspecified cause  NR 
30  2002  GCs  Inactive  GCs  Successful  NR 
32  2004  GCs  Inactive  GCs  Successful  NR 
3  22  2Successful2000Myositis overlaping with APS             
  26  2004  GCs  Inactive  GCs  Stillbirth at 28 weeks gestation  NR 
  28  2006  GCs  Inactive  -GCs-LDA-LMWH  -Prermature delivery at 32 weeks gestation-Neonatal death at day 3  NR 
4  41  Successful  2002Myositis overlaping with SLE  –  –  –  –  –   
  42  Medical termination for unspecified cause    2003  -GCs-AM  Inactive  -GCs-AM  Medical termination for unspecified cause  NR 
    Stillbirth                   
5  25  0  2003DM–  –  –  –  –   
  28    2006  -GCs-AM-MTX  Inactive  -GCs-MTX-AM  Medical termination for unspecified cause  NR 
  29    2007    Inactive  -GCs-AM  Successful  NR 
  26  Successful  2008  DM  2008        Successful  NR 
Ousmane, 2016 [6]2012  Senegal  Black Caribbean  26  Successful  2012  IMNM  –  –  –  –  –  Flare 
2016    Black African  35  Successful  2012  IMNM  –  –  –  –  –  Flare 
Awatef, 2016 [7]  NR  Morocco  North African  28  –  NR  DM  NR  NR  Active  -GCs-AM  Successfull  Improvement 
Cisse, 2018 [8]  NR  Mali  10  Black African  NR  NR  NR  NR  DM  NR  NR  NR  NR  Neonatal cutaneous lupus  NR 
Iba-Ba, 2019 [9]2008–2018Gabon11Black Africans20  NR  NR  NRNR             
21  NR  NR  NR  NR  Inactive  NR  -Caesarean section-Term Live birth  NR 
23  NR  NR  NR  NR  Inactive  NR  -Premature delivery-Caesarean section-SGA  NR 
24  NR  NR  NR  NR  Inactive  NR  -Premature delivery-Caesarean section-SGA  NR 
1229  NR  NR  NR  NR–  –  –  –  –   
36.5  NR  NR    NR  NR  Inactive  NR  Successful  NR 
39.5  NR  NR    NR  NR  Inactive  NR  Successful  NR 

IIM, idiopathic inflammatory myopathy; SLE, systemic lupus erythematosus; GCs, glucocorticoids; AM, antimalarials; NR, not reported; RA, rheumatoid arthritis; MTX, methotrexate; APS, antiphospholipid syndrome; LDA, low-dose aspirin; LMWH, low molecular weight heparin; DM, dermatomyositis; IMNM, immune-mediated necrotizing myopathy; SGA, small for gestational age.

Maternal and offspring outcomes of pre- and post-IIM pregnancies are poorly characterized in Africa. It remains unknown whether the observed adverse outcomes were coincidental or connected with IIMs, although this small pooled sample likely suggests together with studies from other regions1,2 that, increased rates of adverse outcomes may be observed in women (and their infants) with IIMs in Africa as well. There is a need for a prospective multicenter African registry to better assess the link between IIMs and adverse pregnancy outcomes, as well as the impact of pregnancy on IIM activity in Africa.

Funding

This research was not funded.

Conflicts of interest

The authors declare no conflict of interest.

Appendix A
Supplementary data

The following are the supplementary data to this article:

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Copyright © 2021. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
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