Palmsten Kristin, Rolland Matthieu, Hebert Mary F, Clowse Megan E B, Schatz Michael, Xu Ronghui, Chambers Christina D
HealthPartners Institute, Minneapolis, MN, USA.
Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.
Pharmacoepidemiol Drug Saf. 2018 Apr;27(4):430-438. doi: 10.1002/pds.4410. Epub 2018 Feb 28.
To characterize prednisone use in pregnant women with rheumatoid arthritis using individual-level heat-maps and clustering individual trajectories of prednisone dose, and to evaluate the association between prednisone dose trajectory groups and gestational length.
This study included pregnant women with rheumatoid arthritis who enrolled in the MotherToBaby Autoimmune Diseases in Pregnancy Study (2003-2014) before gestational week 20 and reported prednisone use without another oral glucocorticoid during pregnancy (n = 254). Information on medication use and pregnancy outcomes was collected by telephone interview plus by medical record review. Prednisone daily dose and cumulative dose were plotted by gestational day using a heat map for each individual. K-means clustering was used to cluster individual trajectories of prednisone dose into groups. The associations between trajectory group and demographics, disease severity measured by the Health Assessment Questionnaire at enrollment, and gestational length were evaluated.
Women used prednisone 3 to 292 days during pregnancy, with daily doses ranging from <1 to 60 mg. Total cumulative dose ranged from 8 to 6225 mg. Disease severity, non-biologic disease modifying anti-rheumatic drug use, and gestational length varied significantly by trajectory group. After adjusting for disease severity, non-biologic disease modifying anti-rheumatic drug use, and other covariates, the highest vs lowest daily dose trajectory group was associated with reduced gestational age at delivery (β: -2.3 weeks (95%: -3.4, -1.3)), as was the highest vs lowest cumulative dose trajectory group (β: -2.6 weeks (95%: -3.6, -1.5)).
In pregnant women with rheumatoid arthritis, patterns of higher prednisone dose were associated with shorter gestational length compared with lower dose.
使用个体水平热图和泼尼松剂量的个体轨迹聚类来描述类风湿关节炎孕妇使用泼尼松的情况，并评估泼尼松剂量轨迹组与妊娠时长之间的关联。
本研究纳入了在妊娠第20周前参加“孕期母婴自身免疫性疾病研究”（2003 - 2014年）且报告孕期仅使用泼尼松而未使用其他口服糖皮质激素的类风湿关节炎孕妇（n = 254）。通过电话访谈和病历审查收集用药信息和妊娠结局。使用热图按妊娠天数绘制每个个体的泼尼松每日剂量和累积剂量。采用K均值聚类将泼尼松剂量的个体轨迹分为几组。评估轨迹组与人口统计学特征、入组时通过健康评估问卷测量的疾病严重程度以及妊娠时长之间的关联。
女性在孕期使用泼尼松3至292天，每日剂量范围为<1至60毫克。总累积剂量范围为8至6225毫克。疾病严重程度、非生物性改善病情抗风湿药物的使用以及妊娠时长在轨迹组之间存在显著差异。在调整疾病严重程度、非生物性改善病情抗风湿药物的使用及其他协变量后，每日剂量最高轨迹组与最低轨迹组相比，分娩时孕周缩短（β：-2.3周（95%：-3.4，-1.3）），累积剂量最高轨迹组与最低轨迹组相比也是如此（β：-2.6周（95%：-3.6，-1.5））。
在类风湿关节炎孕妇中，与较低剂量相比，较高泼尼松剂量模式与较短妊娠时长相关。
