The impact of increased lupus activity on obstetric outcomes
The impact of increased lupus activity on obstetric outcomes
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DOI：
10.1002/art.20864
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发表时间：
2005-02-01
影响因子：
--
通讯作者：
Petri, M
中科院分区：
文献类型：
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作者：
Clowse, MEB;Magder, LS;Petri, M
目标。系统性红斑狼疮与多种不良妊娠结局有关。我们研究了疾病活动度对自然流产、围产期死亡率、早产和出生体重的影响。该研究旨在评估1987年至2002年间对狼疮患者进行前瞻性观察的所有怀孕情况。在每次访问时，医生对狼疮活动的估计是在视觉模拟量表上确定的（高活动输入定义为2:2的分数）。比较各妊娠期的疾病活动性。我们评估了妊娠期高活动性狼疮对胎龄、活产率的影响，对胎龄婴儿的影响较小。通过多变量分析分析潜在的混杂因素，包括女性的人口统计学特征以及狼疮、肾性狼疮和抗磷脂抗体综合征的母体病史。观察了267例妊娠。其中，229例（85.8%）导致活产。57例妊娠发生高活动性狼疮（21%）。高活动性狼疮患者的妊娠以活产结束（77%对88%的低活动性狼疮患者；P = 0.063）。高活动性狼疮患者中有15例（26%）妊娠足月分娩，而无或轻度狼疮患者中有127例（61%）妊娠足月分娩（P < 0.001）。妊娠早期和中期的高活动性狼疮导致妊娠损失（流产和围产期死亡率）增加3倍。怀孕期间的高活动性狼疮导致早产增加和活产减少，几乎四分之一的怀孕导致胎儿丢失。狼疮患者怀孕期间必须密切关注和治疗，以改善妊娠结局。
Objective. Systemic lupus erythematosus is associated with multiple adverse pregnancy outcomes. We examined the impact of disease activity on spontaneous abortions, perinatal mortality, preterm delivery, and birth weight.Methods. The study was designed to assess all pregnancies in a cohort of lupus patients who were observed prospectively from 1987 to 2002. At each Visit, the physician's estimate of lupus activity was determined on a visual analog scale (high-activity Inputs defined as a score of 2:2). Disease activity in each trimester was compared. We assessed the impact of high-activity lupus during pregnancy on gestational age, live birth rate, and small for gestational age babies. Potential confounders, including demographics of the women as well as maternal history of lupus, renal lupus, and antiphosphoplipid antibody syndrome, were analyzed through multivariate analysis.Results. Two hundred sixty-seven pregnancies were observed. Of these, 229 (85.8%) resulted in a live birth. High-activity lupus occurred in 57 pregnancies (21%). Fewer pregnancies among women with highactivity lupus ended with live births (77% versus 88% of those with low-activity lupus; P = 0.063). Full-term delivery was achieved in 15 pregnancies (26%) among women with high-activity lupus, compared with 127 pregnancies (61%) achieving full-term in those with no or mild lupus activity (P < 0.001). High-activity lupus in the first and second trimesters led to a 3-fold increase in pregnancy loss (miscarriages and perinatal mortality).Conclusion. High-activity lupus during pregnancy leads to increased premature birth and a decrease in live births, with almost one-quarter of these pregnancies resulting in fetal loss. Pregnancies in lupus patients must be closely watched and treated during all trimesters to improve pregnancy outcomes.