What to Expect When Expecting With Systemic Lupus Erythematosus (SLE): A Population-Based Study of Maternal and Fetal Outcomes in SLE and Pre-SLE
What to Expect When Expecting With Systemic Lupus Erythematosus (SLE): A Population-Based Study of Maternal and Fetal Outcomes in SLE and Pre-SLE
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DOI：
10.1002/acr.22791
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发表时间：
2016-07-01
影响因子：
4.7
通讯作者：
Simard, Julia F.
中科院分区：
文献类型：
--
作者：
Arkema, Elizabeth V.;Palmsten, Kristin;Simard, Julia F.
目的评估与亚临床妊娠相关的母儿结局（前系统性红斑狼疮[SLE]和SLE提出长达5年产后）和流行的孕产妇SLE在怀孕期间与一般population.MethodsThis前瞻性队列研究使用人口为基础的瑞典登记册，以确定13,598名妇女首次单胎妊娠登记在医疗出生登记（551例SLE患者，65例0-2年内的SLE前期，133例2-5年内的SLE前期，12，847例一般人群）。SLE定义为患者登记册中2例SLE编码的出院诊断，1例诊断来自专家。未调整的风险，不良妊娠或出生结果计算SLE的状态，和Cochran-Armitage测试评估的趋势跨暴露groups.ResultsMaternal的结果，如先兆子痫，甲状腺功能减退症，中风，感染是更常见的女性SLE。16%的SLE孕妇被诊断为先兆子痫，而一般人群中这一比例为5%。在SLE前期妇女中，26%的SLE患者在产后2年内发现先兆子痫，13%的SLE患者在产后2-5年内发现先兆子痫。同样，婴儿的结局，如早产，感染和死亡率，在那些出生的母亲在怀孕期间患有流行的SLE和SLE前期更糟。测试的趋势是显着的outcome.ConclusionOur数据表明，不利的母亲和胎儿的结果是更常见的SLE妊娠。此外，这些不利的结果在SLE诊断之前发生的妊娠中观察到。因此，潜在的免疫学特征的SLE和改变之前的临床SLE可能有助于这些妊娠并发症。
ObjectiveTo assess maternal and fetal outcomes associated with subclinical (pre-systemic lupus erythematosus [SLE] and SLE presenting up to 5 years postpartum) and prevalent maternal SLE during pregnancy compared with the general population.MethodsThis prospective cohort study used population-based Swedish registers to identify 13,598 women with first singleton pregnancies registered in the Medical Birth Register (551 prevalent SLE, 65 pre-SLE within 0-2 years, 133 pre-SLE within 2-5 years, and 12,847 general population). SLE was defined as 2 SLE-coded discharge diagnoses in the patient register with 1 diagnosis from a specialist. Unadjusted risks of adverse pregnancy or birth outcomes were calculated by SLE status, and Cochran-Armitage tests evaluated trend across exposure groups.ResultsMaternal outcomes such as preeclampsia, hypothyroidism, stroke, and infection were more common among women with SLE. Sixteen percent of prevalent-SLE pregnancies were diagnosed with preeclampsia compared with 5% of those from the general population. Among the pre-SLE women, preeclampsia was found in 26% of those with SLE within 2 years postpartum and 13% in those with SLE within 2-5 years postpartum. Similarly, infant outcomes, such as preterm birth, infection, and mortality, were worse among those born to mothers with prevalent SLE and pre-SLE during pregnancy. The test for trend was significant for most outcomes.ConclusionOur data demonstrate that adverse maternal and fetal outcomes are more common in SLE pregnancies. Furthermore, these unfavorable outcomes are observed in pregnancies occurring prior to the diagnosis of SLE. Thus, the underlying immunologic profile of SLE and alterations preceding clinical SLE may contribute to these pregnancy complications.