Blagojevic Jelena, AlOdhaibi Khitam Abdullah, Aly Aly M, Bellando-Randone Silvia, Lepri Gemma, Bruni Cosimo, Moggi-Pignone Alberto, Guiducci Serena, Mecacci Federico, Matucci-Cerinic Marco, Furst Daniel E
From the Department of Experimental and Clinical Medicine, University of Florence, and the Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, Azienda Ospedaliero Universitaria Careggi (AOUC), Florence, Italy; Department of Family Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Faculty of Medicine, Alexandria University, Alexandria, Egypt; Department of Emergency Medicine, Division of Medicine IV AOUC; Department of Maternal-Neonatal Caref, Careggi University Hospital, Florence, Italy; University of California at Los Angeles, Los Angeles, California; University of Washington, Seattle, Washington, USA; University of Florence, Florence, Italy.
J. Blagojevic, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, AOUC; K.A. AlOdhaibi, MD, Department of Family Medicine, King Faisal Specialist Hospital and Research Centre; A.M. Aly, MBBch, Faculty of Medicine, Alexandria University; S. Bellando-Randone, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, AOUC; G. Lepri, MD, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, AOUC; C. Bruni, MD, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, AOUC; A. Moggi-Pignone, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence, and Department of Emergency Medicine, Division of Medicine IV, AOUC; S. Guiducci, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, AOUC; F. Mecacci, MD, PhD, Department of Maternal-Neonatal Care, Careggi University Hospital; M. Matucci-Cerinic, MD, PhD, Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, AOUC; D.E. Furst, MD, UCLA (Emeritus), and University of Washington.
J Rheumatol. 2020 Jun 1;47(6):881-887. doi: 10.3899/jrheum.181460. Epub 2019 Sep 1.
Through a systematic literature search (SLR) and metaanalysis, to determine maternal and fetal outcomes in pregnancies involving systemic sclerosis (SSc), to analyze the effect of pregnancy on disease activity, and to examine predictors of fetal and maternal outcomes.
An SLR was performed for articles on SSc and pregnancy published between 1950 and February 1, 2018. Reviewers double-extracted articles to obtain agreement on > 95% of predefined critical outcomes.
Out of 461 publications identified, 16 were included in the metaanalysis. The metaanalysis showed that pregnancies involving SSc were at higher risk of miscarriage (OR 1.6, 95% CI 1.22-2.22), fetuses with intrauterine growth retardation (IUGR; OR 3.2, 95% CI 2.21-4.53), preterm births (OR 2.4, 95% CI 1.14-4.86), and newborns with low birth weight (OR 3.8, 95% CI 2.16-6.56). Patients with SSc had a 2.8 times higher chance of developing gestational hypertension (HTN; OR 2.8, 95% CI 2.28-3.39) and a 2.3 times higher chance of cesarean delivery compared to controls (OR 2.3, 95% CI 1.37-3.8). The definitions of disease worsening/new visceral organ involvement were too inexact to have any confidence in the results, although worsening or new disease manifestations during pregnancy in 44/307 cases (14.3%) and 6 months postpartum in 32/306 cases (10.5%) were reported. The data did not permit definition of predictors of disease progression and of maternal and fetal outcomes.
Pregnancies involving SSc have increased frequency of miscarriages, IUGR, preterm deliveries, and newborns with low birth weight compared to healthy controls. Women with SSc were more prone to develop gestational HTN and to undergo cesarean delivery. Disease manifestations seem to remain stable or improve in most patients.
通过系统文献检索（SLR）和荟萃分析，确定系统性硬化症（SSc）患者妊娠的母婴结局，分析妊娠对疾病活动的影响，并研究母婴结局的预测因素。
对1950年至2018年2月1日期间发表的关于SSc和妊娠的文章进行SLR。评审人员对文章进行双重提取，以在超过95%的预定义关键结局上达成一致。
在识别出的461篇出版物中，16篇被纳入荟萃分析。荟萃分析表明，患有SSc的孕妇发生流产（OR 1.6，95%CI 1.22 - 2.22）、胎儿宫内生长受限（IUGR；OR 3.2，95%CI 2.21 - 4.53）、早产（OR 2.4，95%CI 1.14 - 4.86）和低出生体重新生儿（OR 3.8，95%CI 2.16 - 6.56）的风险更高。与对照组相比，SSc患者发生妊娠期高血压（HTN；OR 2.8，95%CI 2.28 - 3.39）的几率高2.8倍，剖宫产的几率高2.3倍（OR 2.3，95%CI 1.37 - 3.8）。疾病恶化/新内脏器官受累的定义不够精确，无法对结果有任何信心，尽管报告了44/307例（14.3%）在孕期和32/306例（10.5%）在产后6个月出现疾病恶化或新的疾病表现。数据无法定义疾病进展以及母婴结局的预测因素。
与健康对照组相比，患有SSc的孕妇流产、IUGR、早产和低出生体重新生儿的发生率增加。患有SSc的女性更容易发生妊娠期HTN并接受剖宫产。大多数患者的疾病表现似乎保持稳定或有所改善。
