Obstetric and Perinatal Outcomes of Pregnancies with Evans Syndrome: A 12-Year Retrospective Study at a Tertiary Care Center in South India

Abstract Background: Evans syndrome (ES), a chronic autoimmune disorder, is infrequently diagnosed during pregnancy and the outcomes are underreported. The aim of the study was to examine the incidence, as well as the maternal and perinatal outcomes of ES in pregnancy over a 12-year period. Methodology: A retrospective review of electronic records at a tertiary care institute in southern India was conducted, which identified 17 women with ES during pregnancy, accounting for a total of 24 pregnancies. Maternal characteristics, treatment modalities, and perinatal outcomes were analyzed. Results: The incidence of ES in pregnancy was 0.104 per 1000 births. Secondary ES was more common, primarily associated with systemic lupus erythematosus. Treatment typically involved steroids and/or hydroxychloroquine, often with other immunosuppressants. Obstetric complications occurred in 66.6% of pregnancies, with fetal growth restriction and hypertension being most frequent. Of the 24 pregnancies, 11 had favorable perinatal outcomes, while 13 resulted in adverse outcomes, including intrauterine demise or stillbirths. Among live births, 41.1% were small for gestational age. None of the neonates had anemia, but four neonates developed thrombocytopenia. No significant correlation was found between maternal factors and neonatal outcomes. Conclusion: ES in pregnancy is rare, but is linked to significant maternal and fetal complications. Regular monitoring of these pregnancies, and of the neonate postdelivery, is essential. The relatively smaller numbers make it challenging to draw definitive conclusions regarding the relationship between maternal risk factors and perinatal outcomes. Larger studies looking at maternal clinical characteristics and perinatal outcomes are needed to establish or refute correlations.