Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Lupus. 2010 Dec;19(14):1665-73. doi: 10.1177/0961203310378669. Epub 2010 Oct 14.
The aim of this study was to examine the pregnancy outcomes in patients with systemic lupus erythematosus (SLE) and the effect of SLE flare and treatment on pregnancy outcomes. We performed a retrospective evaluation of all pregnancies occurring in patients with SLE during the 27-year period from 1980 to 2006. Of the 319 women with SLE planning pregnancy after SLE onset, 176 (55.2%) conceived resulting in 396 pregnancies. Live births were significantly lower in proportion (70.2% vs. 85.7%) and more likely to end in fetal deaths (29.7% vs. 14.2%) and preterm births (26.7% vs. 5.8 %) in pregnancies occurring after SLE onset than in pregnancies occurring before SLE onset (p < 0.0001). With respect to different disease manifestations, we found that fetal loss was significantly higher in patients with antiphospholipid (aPL) antibodies than without (p < 0.001). Preterm deliveries were significantly more frequent in patients with lupus nephritis, anti-Ro/SSA antibodies, hypertension, history of intravenous cyclophosphamide treatment and aPL than those without these features (p < 0.05). Neonates with intrauterine growth retardation (IUGR) neonates were more common in hypertensive and Raynaud's-positive pregnancies (p < 0.05). SLE flares occurred in 30.8% pregnancies. There was increased risk of fetal loss, preterm births and IUGR in pregnancies with SLE exacerbations than without (p < 0.05). Prednisolone was found to improve the rate of live births, although it was also a predictor of prematurity. The predictors of pregnancy loss were lupus nephritis (odds ratio (OR) 7.3), aPL (OR 3.9), and SLE flares in pregnancy (OR 1.9). There was higher risk of preterm deliveries in patients with lupus nephritis (OR 18.9), anti-Ro antibodies (OR 13.9), hypertension (OR 15.7) and SLE flares (OR 2.5). IUGR was found to be associated with hypertension (OR 37.7), Raynaud's (OR 12.3), and SLE flares (OR 4.2). In conclusion, pregnancies in SLE patients with active lupus nephritis, anti-Ro/SSA antibodies, aPL, hypertension, Raynaud's phenomenon, active disease at conception and SLE exacerbations are at a higher risk of adverse pregnancy outcomes. It is important to carefully plan pregnancy, and experienced rheumatologists and obstetricians should monitor SLE patients in pregnancy and postpartum.
本研究旨在探讨系统性红斑狼疮（SLE）患者的妊娠结局，以及 SLE 发作和治疗对妊娠结局的影响。我们对 1980 年至 2006 年 27 年间所有 SLE 患者的妊娠情况进行了回顾性评估。在 SLE 发病后计划妊娠的 319 名 SLE 女性中，176 名（55.2%）受孕，共 396 次妊娠。与 SLE 发病前妊娠相比，SLE 发病后妊娠的活产率明显较低（70.2% vs. 85.7%），胎儿死亡（29.7% vs. 14.2%）和早产（26.7% vs. 5.8%）的风险更高（p < 0.0001）。就不同的疾病表现而言，我们发现抗磷脂（aPL）抗体阳性患者的胎儿丢失率明显高于阴性患者（p < 0.001）。狼疮肾炎、抗 Ro/SSA 抗体、高血压、静脉环磷酰胺治疗史和 aPL 阳性患者的早产发生率明显高于无这些特征的患者（p < 0.05）。高血压和雷诺氏阳性妊娠中宫内生长受限（IUGR）新生儿更为常见（p < 0.05）。SLE 发作发生于 30.8%的妊娠中。与无 SLE 加重的妊娠相比，SLE 加重的妊娠胎儿丢失、早产和 IUGR 的风险增加（p < 0.05）。发现泼尼松可提高活产率，但也是早产的预测因素。狼疮肾炎（比值比（OR）7.3）、aPL（OR 3.9）和妊娠期间的 SLE 发作（OR 1.9）是妊娠丢失的预测因素。狼疮肾炎（OR 18.9）、抗 Ro 抗体（OR 13.9）、高血压（OR 15.7）和 SLE 发作（OR 2.5）患者早产风险较高。IUGR 与高血压（OR 37.7）、雷诺氏（OR 12.3）和 SLE 发作（OR 4.2）有关。总之，SLE 患者合并活动期狼疮肾炎、抗 Ro/SSA 抗体、aPL、高血压、雷诺氏现象、妊娠时疾病活动和 SLE 加重的妊娠发生不良妊娠结局的风险较高。仔细计划妊娠很重要，有经验的风湿病学家和产科医生应在妊娠和产后监测 SLE 患者。
