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).
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 pregnancy | Treatment 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 | 1 | Black African | 30 | 0 | – | 2004 | Myositis overlaping with SLE | 1 | 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] | 1979–2007 | Tunisia | 2 | NR | 21 | 0 | – | 1993 | Myositis overlaping with RA | 0 | – | – | – | – | – | |
| 27 | 1 | 1999 | GCs | Inactive | GCs | Successful | NR | |||||||||
| 28 | 2 | 2000 | -GCs-MTX | Inactive | -GCs-MTX | Medical termination for unspecified cause | NR | |||||||||
| 30 | 3 | 2002 | GCs | Inactive | GCs | Successful | NR | |||||||||
| 32 | 4 | 2004 | GCs | Inactive | GCs | Successful | NR | |||||||||
| 3 | 22 | 2 | Successful | 2000 | Myositis overlaping with APS | |||||||||||
| 26 | 1 | 2004 | GCs | Inactive | GCs | Stillbirth at 28 weeks gestation | NR | |||||||||
| 28 | 2 | 2006 | GCs | Inactive | -GCs-LDA-LMWH | -Prermature delivery at 32 weeks gestation-Neonatal death at day 3 | NR | |||||||||
| 4 | 41 | 3 | Successful | 2002 | Myositis overlaping with SLE | 0 | – | – | – | – | – | |||||
| 42 | 1 | Medical termination for unspecified cause | 1 | 2003 | -GCs-AM | Inactive | -GCs-AM | Medical termination for unspecified cause | NR | |||||||
| 1 | Stillbirth | |||||||||||||||
| 5 | 25 | 0 | 2003 | DM | 0 | – | – | – | – | – | ||||||
| 28 | 1 | 2006 | -GCs-AM-MTX | Inactive | -GCs-MTX-AM | Medical termination for unspecified cause | NR | |||||||||
| 29 | 2 | 2007 | Inactive | -GCs-AM | Successful | NR | ||||||||||
| 6 | 26 | 1 | Successful | 2008 | DM | 1 | 2008 | Successful | NR | |||||||
| Ousmane, 2016 [6] | 2012 | Senegal | 7 | Black Caribbean | 26 | 1 | Successful | 2012 | IMNM | 0 | – | – | – | – | – | Flare |
| 2016 | 8 | Black African | 35 | 1 | Successful | 2012 | IMNM | 0 | – | – | – | – | – | Flare | ||
| Awatef, 2016 [7] | NR | Morocco | 9 | North African | 28 | 0 | – | NR | DM | 1 | NR | NR | Active | -GCs-AM | Successfull | Improvement |
| Cisse, 2018 [8] | NR | Mali | 10 | Black African | NR | NR | NR | NR | DM | 1 | NR | NR | NR | NR | Neonatal cutaneous lupus | NR |
| Iba-Ba, 2019 [9] | 2008–2018 | Gabon | 11 | Black Africans | 20 | NR | NR | NR | NR | |||||||
| 21 | NR | NR | 1 | NR | NR | Inactive | NR | -Caesarean section-Term Live birth | NR | |||||||
| 23 | NR | NR | 2 | NR | NR | Inactive | NR | -Premature delivery-Caesarean section-SGA | NR | |||||||
| 24 | NR | NR | 3 | NR | NR | Inactive | NR | -Premature delivery-Caesarean section-SGA | NR | |||||||
| 12 | 29 | NR | NR | NR | NR | 0 | – | – | – | – | – | |||||
| 36.5 | NR | NR | 1 | NR | NR | Inactive | NR | Successful | NR | |||||||
| 39.5 | NR | NR | 2 | 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.
FundingThis research was not funded.
Conflicts of interestThe authors declare no conflict of interest.
The following are the supplementary data to this article:
