孕前心血管健康与红斑狼疮女性的妊娠结局。
Preconceptional Cardiovascular Health and Pregnancy Outcomes in Women with Systemic Lupus Erythematosus.
机构信息
From the Department of Epidemiology, and the Department of Biostatistics, University of North Carolina Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina; School of Nursing, University of Virginia, Charlottesville, Virginia; Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
A.M. Eudy, PhD, Department of Epidemiology, University of North Carolina Chapel Hill Gillings School of Global Public Health; A.M. Siega-Riz, PhD, School of Nursing, University of Virginia; S.M. Engel, PhD, Department of Epidemiology, University of North Carolina Chapel Hill Gillings School of Global Public Health; N. Franceschini, MD, Department of Epidemiology, University of North Carolina Chapel Hill Gillings School of Global Public Health; A.G. Howard, PhD, Department of Biostatistics, University of North Carolina Chapel Hill Gillings School of Global Public Health; M.E. Clowse, MD, MPH, Division of Rheumatology, Department of Medicine, Duke University Medical Center; M. Petri, MD, MPH, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine.
出版信息
J Rheumatol. 2019 Jan;46(1):70-77. doi: 10.3899/jrheum.171066. Epub 2018 Jul 15.
OBJECTIVE
To estimate the effects of preconceptional cardiovascular (CV) health, measured by American Heart Association (AHA) guidelines, on pregnancy outcomes in women with systemic lupus erythematosus (SLE).
METHODS
The study included patients in the Hopkins Lupus Pregnancy Cohort. Body mass index (BMI), total cholesterol, and blood pressure (BP) in the most recent clinic visit prior to conception or first trimester were used to determine CV health (ideal, intermediate, or poor health) based on AHA definitions. Outcomes included preterm birth, gestational age at birth, and small for gestational age (SGA). Multivariable linear and logistic regression models with generalized estimating equations estimated the association of each CV health factor and outcome.
RESULTS
The analysis included 309 live births. There were 95 preterm births (31%), and of the 293 pregnancies with birth weights, 18% were SGA. Ideal BMI, total cholesterol, and BP were reported in 56%, 85%, and 51% of pregnancies, respectively. Intermediate BMI was associated with decreased odds of SGA (OR 0.26, 95% CI 0.11-0.63), adjusted for race and prednisone use. Intermediate/poor total cholesterol was associated with increased odds of preterm birth (OR 2.21, 95% CI 1.06-4.62). Intermediate/poor BP was associated with decreased gestational age at birth (β -0.96, 95% CI -1.62 to -0.29).
CONCLUSION
Poor/intermediate preconception CV health affects pregnancy outcomes of preterm birth and SGA infants among women with SLE. Efforts to maintain BMI, total cholesterol, and BP within the recommended ideal range prior to pregnancy is important to improve pregnancy outcomes in women with SLE.
目的
根据美国心脏协会（AHA）指南评估孕前心血管（CV）健康状况对系统性红斑狼疮（SLE）女性妊娠结局的影响。
方法
本研究纳入了霍普金斯狼疮妊娠队列的患者。根据 AHA 定义，采用孕前或早孕期最近一次就诊时的体重指数（BMI）、总胆固醇和血压（BP）来确定 CV 健康状况（理想、中等或不良）。结局包括早产、出生时的胎龄和小于胎龄儿（SGA）。使用广义估计方程的多变量线性和逻辑回归模型估计了每个 CV 健康因素与结局的相关性。
结果
分析纳入了 309 例活产儿。有 95 例早产（31%），在 293 例有出生体重的妊娠中，18%为 SGA。分别有 56%、85%和 51%的妊娠报告理想 BMI、总胆固醇和 BP。中等 BMI 与 SGA 的可能性降低相关（OR 0.26，95%CI 0.11-0.63），调整种族和泼尼松使用后。中等/不良总胆固醇与早产的可能性增加相关（OR 2.21，95%CI 1.06-4.62）。中等/不良 BP 与出生时胎龄减少相关（β-0.96，95%CI-1.62 至-0.29）。
结论
SLE 女性孕前 CV 健康状况不良/中等会影响早产和 SGA 婴儿的妊娠结局。在 SLE 女性中，努力在孕前将 BMI、总胆固醇和 BP 维持在推荐的理想范围内，对改善妊娠结局很重要。
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