美国系统性红斑狼疮孕妇的母婴结局趋势：一项横断面分析。
Trends in Maternal and Fetal Outcomes Among Pregnant Women With Systemic Lupus Erythematosus in the United States: A Cross-sectional Analysis.
机构信息
Hospital for Special Surgery and Weill Cornell Medicine, New York, New York (B.M., L.S., J.S., M.L., S.G.).
Mount Sinai St. Luke's, Mount Sinai West, and Icahn School of Medicine, New York, New York (Y.L.).
出版信息
Ann Intern Med. 2019 Aug 6;171(3):164-171. doi: 10.7326/M19-0120. Epub 2019 Jul 9.
BACKGROUND
Although pregnancy in systemic lupus erythematosus (SLE) carries a high risk for mother and fetus, outcomes may be improving.
OBJECTIVE
To assess nationwide trends and disparities in maternal and fetal complications among pregnant women with SLE.
DESIGN
Retrospective cohort study.
SETTING
United States, 1998 to 2015.
PATIENTS
Adult pregnant women with and without SLE who had hospitalizations recorded in the National Inpatient Sample (NIS) database.
MEASUREMENTS
Outcome measures were in-hospital maternal mortality, fetal mortality, preeclampsia or eclampsia, caesarean sections, non-delivery-related admissions, and length of stay. To assess whether trends in outcomes over time differed between patients with SLE and those without SLE, logistic or linear regression with an interaction term between year and SLE (yes or no) was used. Nationwide population estimates incorporating sampling and poststratification weights were obtained.
RESULTS
An estimated 93 820 pregnant women with SLE and 78 045 054 without SLE were hospitalized in the United States from 1998 through 2015. Outcomes improved during those 18 years. In-hospital maternal deaths (per 100 000 admissions) declined among patients with as well as those without SLE (442 vs. 13 for 1998 to 2000 and <50 vs. 10 for 2013 to 2015), although the decrease was greater in women with SLE (difference in trends, P < 0.002). The percentage of patients with SLE in all pregnancy-related, as well as delivery-related, admissions increased significantly.
LIMITATIONS
The sample for this analysis was identified by using diagnostic codes; detailed information on hospital-specific trends, SLE disease activity, and medications was not available. Race trends could not be analyzed. Given that NIS uses weighted estimates, the incidence of outcomes reported may not be exact.
CONCLUSION
In this large study examining SLE and non-SLE pregnancies over 18 years, in-hospital maternal mortality and overall outcomes improved markedly, particularly among women with SLE. However, improvement is still needed, because SLE pregnancy risks remain high.
PRIMARY FUNDING SOURCE
None.
背景
尽管系统性红斑狼疮（SLE）患者妊娠对母婴均存在较高风险，但结局可能正在改善。
目的
评估全美 SLE 患者妊娠的母婴并发症的趋势和差异。
设计
回顾性队列研究。
设置
美国，1998 年至 2015 年。
患者
美国国家住院患者样本数据库中记录有住院的成年妊娠妇女，包括 SLE 患者和非 SLE 患者。
测量指标
主要结局为院内孕产妇死亡率、胎儿死亡率、子痫前期或子痫、剖宫产术、非分娩相关入院和住院时间。为评估结局随时间的变化趋势在 SLE 患者和非 SLE 患者之间是否存在差异，采用 logistic 或线性回归，并在模型中加入年份和 SLE 之间的交互项。采用包含抽样和事后分层权重的全美人群估计值。
结果
1998 年至 2015 年，美国共有 93 820 例 SLE 妊娠患者和 78 045 054 例非 SLE 妊娠患者住院。这 18 年中，结局得到改善。SLE 患者和非 SLE 患者的院内孕产妇死亡（每 100 000 例入院人数）均有所下降（1998 年至 2000 年为 442 例，2013 年至 2015 年为 <50 例；1998 年至 2000 年为 13 例，2013 年至 2015 年为 10 例），但 SLE 患者的降幅更大（趋势差异，P<0.002）。SLE 患者在所有妊娠相关和分娩相关住院患者中的比例均显著增加。
局限性
本分析的样本是通过诊断代码确定的；无法获取医院特定趋势、SLE 疾病活动和药物治疗的详细信息。种族趋势无法分析。由于 NIS 使用加权估计值，因此报告的结局发生率可能并不准确。
结论
在这项对 18 年中 SLE 和非 SLE 妊娠的大型研究中，院内孕产妇死亡率和总体结局显著改善，尤其是在 SLE 患者中。然而，仍需进一步改善，因为 SLE 妊娠风险仍然较高。
主要资金来源
无。
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