Adverse pregnancy outcomes in women with systemic lupus erythematosus from a multiethnic US cohort: LUMINA (LVI) [corrected].
Adverse pregnancy outcomes in women with systemic lupus erythematosus from a multiethnic US cohort: LUMINA (LVI) [corrected].
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发表时间：
2008-03
影响因子：
3.7
通讯作者：
R. Andrade;Martha L. Sanchez;G. Alarcón;B. Fessler;Mónica;Fernández;A. Bertoli;M. Apte;L. Vilá;A. M. Arango;J. Reveille
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作者：
R. Andrade;Martha L. Sanchez;G. Alarcón;B. Fessler;Mónica;Fernández;A. Bertoli;M. Apte;L. Vilá;A. M. Arango;J. Reveille
目的探讨系统性红斑狼疮（SLE）患者不良妊娠结局的相关因素。方法研究了来自LUMINA的西班牙裔、非洲裔美国人和白人种族的SLE妇女。不良妊娠结局为流产或流产（≥ 20）和/或中度至重度早产儿（≥ 34周）或足月婴儿[剖腹产或阴道分娩（38-42周）]。纳入SLE诊断（TD）后发生的妊娠;妊娠结局是分析单位。选择的变量和妊娠结局之间的关系进行了单变量和多变量分析。结果102例妊娠中不良结局发生率为63.7%。在单变量分析中，德克萨斯西班牙裔和非洲裔美国人种族，受教育年限较少，ACR标准数量较多，肾脏受累，糖皮质激素暴露和妊娠结局前使用的糖皮质激素最大剂量与不良妊娠结局相关。肾脏受累与不良妊娠结局独立相关[比值比（OR）=5.219（95%置信区间（CI）1.416-19.239，p=0.0131），以及妊娠结局前使用的糖皮质激素最大剂量（OR=1.028; CI：1.002-1.054; p=0.0315）和受教育年限较少（OR=1.204; CI：1.006-1.472; p=0.0437）。多变量模型中未保留种族。结论肾损害、孕前使用最大剂量糖皮质激素和受教育年限较短与不良妊娠结局相关。这些数据对计划怀孕的狼疮妇女的管理有影响。
OBJECTIVE To study the factors associated with an adverse pregnancy outcome in women with systemic lupus erythematosus (SLE). METHODS SLE women from LUMINA of Hispanic, African American and Caucasian ethnicity were studied. Adverse pregnancy outcome was a miscarriage or abortion ( or = 20) and/or a moderate to severe preterm-baby ( or = 34 weeks) or a full-term baby [C-section or vaginal delivery (38-42 weeks)]. Pregnancies occurring after SLE diagnosis (TD) were included; pregnancy outcome was the unit of analyses. The relationship between selected variables and pregnancy outcomes was examined by univariable and multivariable analyses. RESULTS Adverse outcomes occurred in 63.7% of 102 pregnancies. In the univariable analyses, Texan Hispanic and African American ethnicities, fewer years of education, higher number of ACR criteria, renal involvement, glucocorticoid exposure and the maximum dose of glucocorticoids used prior to the pregnancy outcome were associated with an adverse pregnancy outcome. Renal involvement was independently associated with an adverse pregnancy outcome [Odds ratio (OR)=5.219 (95% Confidence Interval (CI) 1.416-19.239, p=0.0131] as were the maximum dose of glucocorticoids used prior to the pregnancy outcome (OR=1.028; CI:1.002-1.054; p=0.0315) and fewer years of education (OR=1.204; CI:1.006-1.472; p=0.0437). Ethnicity was not retained in the multivariable model. CONCLUSION Renal involvement, the maximum dose of glucocorticoids used prior to pregnancy and fewer years of education were associated with adverse pregnancy outcomes. These data have implications for the management of women with lupus planning to become pregnant.