慢性炎症性关节炎女性的妊娠与分娩，特别关注初产情况。

Pregnancy and delivery in women with chronic inflammatory arthritides with a specific focus on first birth.

作者信息

Wallenius Marianne, Skomsvoll Johan F, Irgens Lorentz M, Salvesen Kjell Å, Nordvåg Bjorn Y, Koldingsnes Wenche, Mikkelsen Knut, Kaufmann Cecilie, Kvien Tore K

机构信息

Department of Rheumatology, Trondheim University Hospital and Norwegian University of Science and Technology, Trondheim, Norway.

出版信息

Arthritis Rheum. 2011 Jun;63(6):1534-42. doi: 10.1002/art.30210.

DOI:10.1002/art.30210

PMID:21630243

Abstract

OBJECTIVE

To examine possible associations between chronic inflammatory arthritides and pregnancy outcomes with separate analyses of first and subsequent births before and after diagnosis.

METHODS

Linkage of data from a registry of patients with chronic inflammatory arthritides and the Medical Birth Registry of Norway enabled a comparison of pregnancy outcomes in women with chronic inflammatory arthritides and pregnancy outcomes in reference subjects. Outcomes of first birth and subsequent births before and after diagnosis were analyzed separately. Associations between chronic inflammatory arthritides and the women's health during pregnancy and delivery as well as perinatal outcomes were assessed in logistic regression analyses with adjustments for maternal age at delivery and gestational age.

RESULTS

We analyzed 128 first births and 151 subsequent births after diagnosis and 286 first births and 262 subsequent births before diagnosis in patients and compared them with first and subsequent births in reference subjects. Firstborn children of women diagnosed as having chronic inflammatory arthritides were more often preterm (odds ratio [OR] 1.85 [95% confidence interval (95% CI) 1.09-3.13]) and small for gestational age (OR 1.60 [95% CI 1.00-2.56]). They also had lower mean birth weight (P=0.01) and higher perinatal mortality (OR 3.26 [95% CI 1.04-10.24]). Birth by caesarean section (all classifications) was more frequent in patients than in reference subjects, and elective caesarean section was 2-fold more frequent in patients, both in first birth (OR 2.60 [95% CI 1.43-4.75]) and in subsequent births (OR 2.18 [95% CI 1.33-3.58]). No excess risks of clinical importance were observed prior to diagnosis of chronic inflammatory arthritides.

CONCLUSION

Excess risks were related to first birth in women diagnosed as having chronic inflammatory arthritides, including a higher rate of perinatal mortality. A higher caesarean section rate was related to all patient deliveries. Mainly, pregnancy outcomes before diagnosis did not differ from those in reference subjects.

摘要

目的

通过对诊断前后首次分娩和后续分娩进行单独分析，研究慢性炎症性关节炎与妊娠结局之间可能存在的关联。

方法

将慢性炎症性关节炎患者登记处的数据与挪威医疗出生登记处的数据相链接，从而能够比较慢性炎症性关节炎女性的妊娠结局与对照人群的妊娠结局。分别分析诊断前后首次分娩和后续分娩的结局。在对分娩时产妇年龄和孕周进行校正的逻辑回归分析中，评估慢性炎症性关节炎与妊娠及分娩期间女性健康以及围产期结局之间的关联。

结果

我们分析了患者诊断后128例首次分娩和151例后续分娩，以及诊断前286例首次分娩和262例后续分娩，并将其与对照人群的首次和后续分娩进行比较。被诊断患有慢性炎症性关节炎的女性所生的头胎子女更常出现早产（比值比[OR]1.85[95%置信区间(95%CI)1.09 - 3.13]）和小于胎龄（OR 1.60[95%CI 1.00 - 2.56]）。他们的平均出生体重也较低（P = 0.０1）且围产期死亡率较高（OR 3.26[95%CI 1.04 - 10.24]）。患者剖宫产（所有分类）的发生率高于对照人群，择期剖宫产在患者中更为常见，无论是首次分娩（OR 2.60[95%CI 1.43 - 4.75]）还是后续分娩（OR 2.18[95%CI 1.33 - 3.58]）。在诊断慢性炎症性关节炎之前，未观察到具有临床重要性的额外风险。