Tsuda Sayaka, Sameshima Azusa, Sekine Michikazu, Kawaguchi Haruna, Fujita Daisuke, Makino Shintaro, Morinobu Akio, Murakawa Yohko, Matsui Kiyoshi, Sugiyama Takao, Watanabe Mamoru, Suzuki Yasuo, Nagahori Masakazu, Murashima Atsuko, Atsumi Tatsuya, Oku Kenji, Mitsuda Nobuaki, Takei Syuji, Miyamae Takako, Takahashi Naoto, Nakajima Ken, Saito Shigeru
Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan.
Department of Epidemiology and Health Policy, Graduate School of Medicine and Pharmaceutical Sciences University of Toyama, Toyama, Japan.
Mod Rheumatol. 2020 Sep;30(5):852-861. doi: 10.1080/14397595.2019.1661592. Epub 2019 Sep 24.
To describe the pre-conception status, pregnancy outcomes, and medication prevalence in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Crohn's disease (CD), and ulcerative colitis (UC). E-mail-based questionnaire survey for the Japan Maternal Fetal Intensive Care Unit Network hospitals inquiring prevalence and clinical features of SLE, RA, CD and UC complicated pregnancies for 2 years. The number of SLE, RA, CD and UC among 69,810 deliveries was 184, 139, 27 and 178, respectively. Less than half of pregnancies were planned. Assisted reproductive technology (ART) pregnancy rates were higher in SLE, RA and UC than in the general population (11.4, 23.0 and 7.4 vs 5.1%, < .001 each). Preterm delivery, preeclampsia, and fetal growth restriction (FGR) were more frequent in SLE than in the general population (39.4 vs. 5.6% < .001, 15.0 vs. 6.0% < .001, 12.9 vs 4.2% < .001). Prevalence of preterm delivery in RA and UC (27.5 vs. 5.6% < .001, 11.3 vs. 5.6% < .05) and FGR in CD (28.6 vs. 4.2% < .001) was also higher than that in the general population. SLE, RA, CD, and UC complicated pregnancies were at high risks of obstetric adverse outcome. High ART rates necessitate pre-conception counseling in SLE, RA, and UC pregnancies.
描述系统性红斑狼疮（SLE）、类风湿性关节炎（RA）、克罗恩病（CD）和溃疡性结肠炎（UC）的孕前状况、妊娠结局及药物使用情况。对日本母胎重症监护病房网络医院进行基于电子邮件的问卷调查，询问SLE、RA、CD和UC合并妊娠的患病率及临床特征，为期2年。在69810例分娩中，SLE、RA、CD和UC的病例数分别为184例、139例、27例和178例。计划妊娠的比例不到一半。SLE、RA和UC的辅助生殖技术（ART）妊娠率高于普通人群（分别为11.4%、23.0%和7.4%，而普通人群为5.1%，均P<0.001）。SLE患者早产、先兆子痫和胎儿生长受限（FGR）的发生率高于普通人群（分别为39.4%对5.6%，P<0.001；15.0%对6.0%，P<0.001；12.9%对4.2%，P<0.001）。RA和UC的早产发生率（分别为27.5%对5.6%，P<0.001；11.3%对5.6%，P<0.05）以及CD的FGR发生率（28.6%对4.2%，P<0.001）也高于普通人群。SLE、RA、CD和UC合并妊娠具有产科不良结局的高风险。SLE、RA和UC妊娠的ART率较高，因此需要进行孕前咨询。
