From the Division of General Internal Medicine, and the Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montréal; Division of Rheumatology, Department of Medicine, University of Sherbrooke, Sherbrooke, Québec; Division of Rheumatology, Mary Pack Arthritis Center, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton; Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
E.G. McDonald, MD, MSc, Division of General Internal Medicine, Department of Medicine, McGill University Health Centre; L. Bissonette, MD, Division of Rheumatology, Department of Medicine, University of Sherbrooke; S. Ensworth, MD, Assistant Professor, Division of Rheumatology, University of British Columbia; N. Dayan, MD, MSc, Division of General Internal Medicine, Department of Medicine, McGill University Health Centre; A.E. Clarke, MD, MSc, Division of Rheumatology, Department of Medicine, University of Calgary; S. Keeling, MD, MSc, Division of Rheumatology, Department of Medicine, University of Alberta; S. Bernatsky, MD, PhD, Division of Rheumatology, Department of Medicine, McGill University Health Centre; E. Vinet, MD, PhD, Division of Rheumatology, Department of Medicine, McGill University Health Centre.
J Rheumatol. 2018 Oct;45(10):1477-1490. doi: 10.3899/jrheum.171023. Epub 2018 Jul 15.
Few data exist to guide the frequency and type of monitoring in systemic lupus erythematosus (SLE) pregnancies. A systematic literature review was performed to address this gap in the literature.
A systematic review of original articles (1975-2015) was performed using Medline, Embase, and Cochrane Library. We included search terms for SLE, pregnancy, and monitoring. We also hand-searched reference lists, review articles, and grey literature for additional relevant articles.
The search yielded a total of 1106 articles. After removing 117 duplicates, 929 articles that were evidently unrelated to our topic based on title and/or abstract, and 7 that were in a language other than English or French, 53 articles were included for full-text review. Following a more in-depth review, 15 were excluded: 6 did not use any measure of SLE activity and 6 did not specifically address SLE monitoring in pregnancy; 1 case series, 1 review, and 1 metaanalysis were removed. Among the 38 included studies, presence of active disease, antiphospholipid (aPL) antibodies positivity, and abnormal uterine and umbilical artery Doppler studies predicted poor pregnancy outcomes. No studies evaluated an evidence-based approach to the frequency of monitoring.
Few existing studies address monitoring for optimal care during SLE pregnancies. The available data imply roles for aPL antibodies measurement (prior to pregnancy and/or during the first trimester), uterine and umbilical artery Doppler studies in the second trimester, and following disease activity. Optimal frequency of monitoring is not addressed in the existing literature.
关于系统性红斑狼疮（SLE）妊娠的监测频率和类型，目前仅有少量数据可用于指导临床实践。本研究通过系统文献回顾旨在填补该领域的文献空白。
通过 Medline、Embase 和 Cochrane Library 对 1975 年至 2015 年间的原始文章进行系统评价。我们使用了 SLE、妊娠和监测等术语进行搜索。我们还通过手工搜索参考文献、综述文章和灰色文献来查找其他相关文章。
检索共获得 1106 篇文章。去除 117 篇重复文献后，根据标题和/或摘要判断 929 篇文章与我们的主题不相关，另外 7 篇文章的语言不是英语或法语，因此对 53 篇文章进行全文审查。经过更深入的审查，排除了 15 篇文章：6 篇文章未使用任何 SLE 活动的衡量标准，6 篇文章未专门讨论 SLE 妊娠监测；排除了 1 篇病例系列研究、1 篇综述和 1 篇荟萃分析。在纳入的 38 项研究中，存在疾病活动、抗磷脂（aPL）抗体阳性和异常的子宫和脐带动脉多普勒研究与不良妊娠结局相关。没有研究评估监测频率的循证方法。
目前仅有少量研究探讨 SLE 妊娠期间的最佳监测方法。现有数据表明，在妊娠前和/或妊娠早期检测 aPL 抗体、在妊娠中期进行子宫和脐带动脉多普勒研究以及监测疾病活动有助于改善妊娠结局。但目前的文献并未探讨最佳的监测频率。
