The importance of pregnancy planning in lupus pregnancies.
The importance of pregnancy planning in lupus pregnancies.
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DOI：
10.1177/0961203321989803
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发表时间：
2021-04
期刊：
影响因子：
2.6
通讯作者：
Clowse MEB
中科院分区：
文献类型：
--
作者：
Rajendran A;Eudy AM;Balevic SJ;Clowse MEB
为了寻求改善狼疮妊娠结局的新方法，我们研究了妊娠计划、美国风湿病学会生殖健康指南2020推荐的行为与妊娠和婴儿结局之间的关系。在前瞻性登记（2018年1月1日至2020年4月1日）中，狼疮妊娠使用患者报告的伦敦意外妊娠量表（London Measure of non -planned Pregnancy）被分类为计划妊娠或非计划妊娠。这些组在人口统计学、孕前疾病活动、怀孕计划行为和分娩结果方面进行比较。在43名单胎怀孕的女性中，平均年龄为29.4岁，其中42%是黑人。总体而言，60%为计划妊娠，40%为非计划妊娠（16例矛盾妊娠，1例非计划妊娠）。非计划怀孕的妇女年龄、收入和受教育程度较低，需要更多的医疗补助。当狼疮活动度较高时，非计划怀孕的妇女更有可能怀孕（p=0.001），更不可能接受风湿病学家的孕前咨询（p=0.02），更不可能继续使用妊娠相容药物（p=0.03）。非计划妊娠妇女的严重不良妊娠结局（APOs）和严重新生儿结局高于计划妊娠妇女（43%比0% p=0.003； 70%比30% p=0.06）。本研究确定怀孕意向是狼疮患者预后不良的潜在可改变的风险因素。它突出了一个独特的人群与狼疮妇女在怀孕和婴儿并发症的高风险：那些矛盾的怀孕。这些妇女可能没有有效地采取预防怀孕的健康行为，也没有为安全怀孕做准备。通过有效的妊娠计划和避孕指导，我们可以降低母胎发病率和死亡率的风险。
In seeking new approaches to improve lupus pregnancy outcomes, we study the association between pregnancy planning, behaviors recommended by American College of Rheumatology’s Reproductive Health Guideline 2020, and pregnancy and infant outcomes. Lupus pregnancies in a prospective registry (1/1/2018 to 4/1/2020) were classified as planned or not-planned using the patient-reported London Measure of Unplanned Pregnancy. These groups were compared for demographics, pre-pregnancy disease activity, pregnancy planning behaviors, and delivery outcomes. Among 43 women with 43 singleton pregnancies the average age was 29.4 years and 42% were Black. Overall, 60% were planned pregnancies and 40% were not-planned (16 ambivalent, 1 unplanned). Women with not-planned pregnancies had lower age, income, and education, and more required Medicaid. Women with not-planned pregnancies were more likely to conceive when lupus activity was higher (p=0.001), less likely to receive pre-pregnancy counseling with a rheumatologist (p=0.02), and less likely to continue pregnancy-compatible medications (p=0.03). Severe PROMISSE adverse pregnancy outcomes (APOs) and severe neonatal outcomes were higher among women with not-planned than planned pregnancies (43% vs 0% p=0.003; 70% vs 30% p=0.06). This study identifies pregnancy intention as a potentially modifiable risk factor for poor outcomes in women with lupus. It highlights a unique population of women with lupus at high risk for pregnancy and infant complications: those ambivalent about pregnancy. These women may not be effectively engaging in health behaviors that prevent pregnancy nor those that will prepare for a safe pregnancy. With effective pregnancy planning and contraception guidance, we may decrease their risk for maternal-fetal morbidity and mortality.
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