Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Ann Rheum Dis. 2018 Jun;77(6):855-860. doi: 10.1136/annrheumdis-2017-212535. Epub 2018 Feb 20.
Prior studies found conflicting results about whether lupus is likely to flare during or after pregnancy. Using a large cohort of pregnant and non-pregnant women with lupus, we estimated the effect of pregnancy on disease flares in systemic lupus erythematosus.
Data were collected in the Hopkins Lupus Cohort 1987-2015. Women aged 14-45 years with >1 measurement of disease activity were included. The time-varying exposures were classified as pregnancy, postpartum or non-pregnant/non-postpartum periods. Flares were defined as: (1) change in Physician Global Assessment (PGA)≥1 from previous visit and (2) change in Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI)≥4 from previous visit. A stratified Cox model estimated HRs with bootstrap 95% CIs.
There were 1349 patients, including 398 pregnancies in 304 patients. There was an increased rate of flare defined by PGA during pregnancy (HR: 1.59; 95% CI 1.27 to 1.96); however, this effect was modified by hydroxychloroquine (HCQ) use, with the HR of flares in pregnancy compared with non-pregnant/non-postpartum periods estimated to be 1.83 (95% CI 1.34 to 2.45) for patients with no HCQ use and 1.26 (95% CI 0.88 to 1.69) for patients with HCQ use. The risk of flare was similarly elevated among non-HCQ users in the 3 months postpartum, but not for women taking HCQ after delivery.
Our study supports and extends previous findings that the incidence of flare is increased during pregnancy and within the 3 months postpartum. Continuing HCQ, however, appeared to mitigate the risk of flare during and after pregnancy.
先前的研究对于狼疮是否可能在怀孕期间或之后发作存在相互矛盾的结果。使用大量患有狼疮的孕妇和非孕妇队列，我们估计妊娠对系统性红斑狼疮疾病发作的影响。
数据收集于 1987 年至 2015 年的霍普金斯狼疮队列。纳入年龄在 14-45 岁且有>1 次疾病活动测量的女性。时间变化的暴露被分为妊娠、产后或非妊娠/非产后期。发作定义为：（1）上次就诊时医生整体评估（PGA）变化≥1；（2）上次就诊时安全性雌激素在狼疮国家评估-系统性红斑狼疮疾病活动指数（SELENA-SLEDAI）变化≥4。分层 Cox 模型使用自举 95%CI 估计 HR。
共有 1349 名患者，其中 304 名患者中有 398 次妊娠。妊娠期间 PGA 定义的发作率增加（HR：1.59；95%CI 1.27 至 1.96）；然而，这种影响被羟氯喹（HCQ）的使用所修饰，与非妊娠/非产后期间相比，妊娠期间的发作风险估计为无 HCQ 使用者的 1.83（95%CI 1.34 至 2.45）和 HCQ 使用者的 1.26（95%CI 0.88 至 1.69）。在没有使用 HCQ 的患者中，产后 3 个月的发作风险也同样升高，但在产后使用 HCQ 的女性中则没有。
我们的研究支持并扩展了先前的发现，即发作的发生率在怀孕期间和产后 3 个月内增加。然而，继续使用 HCQ 似乎减轻了妊娠期间和之后发作的风险。
