Normand G, Sens F, Puthet J, Jourde-Chiche N, Lemoine S, Chauveau D, Moranne O, Rémy P, Doret M, Daugas E, Juillard L
1 Department of Nephrology, Hypertension and Dialysis, Hospices Civils de Lyon, Lyon, France.
2 University of Lyon 1, Lyon, France.
Lupus. 2019 Apr;28(4):529-537. doi: 10.1177/0961203319832097. Epub 2019 Feb 24.
Pregnancies in women with lupus nephritis are at high-risk of complications, while scarcity of scientific knowledge on prognostic factors impedes a fair medical counseling. We aimed to identify determinants associated with maternal and fetal complications.
We retrospectively reviewed medical charts of pregnancies that lasted more than 22 weeks in 66 patients with pre-existing lupus nephritis between 2004 and 2013 in France. Univariate and multivariate analyses were conducted to identify determinants for maternal complications, lupus renal flare and fetal prematurity or death.
Eighty-four pregnancies were identified. A maternal complication occurred in 31 pregnancies (36.9%): mostly preeclampsia (17 pregnancies, 20.2%) and renal flares (12 pregnancies, 14.3%). Overall fetal survival was 94.0% (79/84). Maternal pregnancy complications were independently associated with prepregnancy body mass index >25 kg/m (OR 3.81, 95% CI 1.03-14.09) and immunological activity (positive anti-dsDNA antibodies or Farr assay lupus) (OR 4.95, 95% CI 1.33-18.43). Renal lupus flares were independently associated with maternal age (OR 1.50, 95% CI 1.12-2.01) and prepregnancy immunological activity (OR 15.99, 95% CI 1.57-162.68) while a remission time >12 months had a protective effect (OR 0.17, 95% CI 0.04-0.68). Three parameters were associated with a higher risk of fetal prematurity or death: a prepregnancy body mass index >25 kg/m (HR 3.58, 95% CI 1.45-8.83), hypertension (HR 8.97, 95% CI 3.32-24.25), and immunological activity (HR 3.34, 95% CI 1.30-8.63).
Maternal age, prepregnancy hypertension, body mass index >25 kg/m and lupus immunological activity may be considered as the main determinants for fetal and maternal complications. A remission time above 12 months for patients with lupus nephritis could be associated with a reduced risk of renal flare during pregnancy.
狼疮性肾炎女性的妊娠存在并发症的高风险，而关于预后因素的科学知识匮乏阻碍了合理的医学咨询。我们旨在确定与母婴并发症相关的决定因素。
我们回顾性分析了2004年至2013年期间法国66例既往有狼疮性肾炎的患者中持续超过22周的妊娠病历。进行单因素和多因素分析以确定孕产妇并发症、狼疮性肾炎复发以及胎儿早产或死亡的决定因素。
共确定了84例妊娠。31例妊娠（36.9%）出现孕产妇并发症：主要是子痫前期（17例妊娠，20.2%）和肾炎复发（12例妊娠，14.3%）。总体胎儿存活率为94.0%（79/84）。孕产妇妊娠并发症与孕前体重指数>25kg/m²（比值比3.81，95%置信区间1.03 - 14.09）和免疫活性（抗双链DNA抗体阳性或法尔氏试验狼疮阳性）（比值比4.95，95%置信区间1.33 - 18.43）独立相关。狼疮性肾炎复发与孕产妇年龄（比值比1.50，95%置信区间1.12 - 2.01）和孕前免疫活性（比值比15.99，95%置信区间1.57 - 162.68）独立相关，而缓解时间>12个月具有保护作用（比值比0.17，95%置信区间0.04 - 0.68）。三个参数与胎儿早产或死亡的较高风险相关：孕前体重指数>25kg/m²（风险比3.58，95%置信区间1.45 - 8.83）、高血压（风险比8.97，95%置信区间3.32 - 24.25）和免疫活性（风险比3.34，95%置信区间1.30 - 8.63）。
孕产妇年龄、孕前高血压、体重指数>25kg/m²和狼疮免疫活性可被视为母婴并发症的主要决定因素。狼疮性肾炎患者缓解时间超过12个月可能与孕期肾炎复发风险降低有关。
