Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan.
Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Lupus. 2019 Oct;28(12):1407-1416. doi: 10.1177/0961203319877258. Epub 2019 Sep 24.
We aimed to evaluate the obstetric complications and the risk factors for these events in pregnant women with rheumatic diseases (RDs).
A single-center retrospective study of women with RDs at Hokkaido University Hospital between 2007 and 2016 was conducted. Clinical features and maternal and fetal outcomes were retrospectively collected. The rate of pregnancy complications was compared with the general obstetric population (GOP) in Japan.
Overall, 132 pregnancies in 95 women with RDs were recorded. Underlying RDs were systemic erythematosus (SLE) ( = 57), antiphospholipid syndrome (APS) ( = 35), rheumatoid arthritis ( = 9), and other RDs ( = 31). Antiphospholipid antibodies (aPL) were detected in 44 pregnancies (32%). Glucocorticoid was used in 82 pregnancies (62%), and tacrolimus in 20 pregnancies (15%). There were 24 disease flares (18%), but no RD-related death was documented. We recorded 112 live births, 6 abortions, 8 miscarriages, and 6 stillbirths. Pregnancies with RDs appeared to have frequent, emergency cesarean sections and preterm deliveries compared with GOP (30% vs 15% and 21% vs 14%, respectively). The median [interquartile range] birthweight in SLE and APS was lower than GOP (2591 [2231-2958] g and 2600 [2276-2920] g vs 2950 [2650-3250] g, respectively). In pregnancies with SLE, low complement levels presented the risk of maternal complications (odds ratio [95% CI]; 3.9 [1.0-14.9], = 0.046) and anti-DNA antibody positivity was significantly correlated with the risk of fetal complications (3.5 [1.1-11.2], = 0.036). In pregnancies with APS, maternal age over 35 years and duration of disease longer than 9 years (7.4 [1.3-40.8], = 0.021, and 11.16 [1.1-118.8], = 0.046, respectively) were significantly correlated with the risk of fetal complications.
Pregnancies with RDs were at increased risk of having both maternal complications and adverse neonatal outcomes, indicating these pregnancies should be closely monitored.
评估患有风湿性疾病（RDs）的孕妇的产科并发症及其相关风险因素。
对北海道大学医院 2007 年至 2016 年间的 RDs 孕妇进行了单中心回顾性研究。回顾性收集了临床特征、母婴结局等数据。将妊娠并发症的发生率与日本一般产科人群（GOP）进行了比较。
共记录了 95 名 RDs 孕妇的 132 次妊娠。基础 RDs 为系统性红斑狼疮（SLE）（n=57）、抗磷脂综合征（APS）（n=35）、类风湿关节炎（n=9）和其他 RDs（n=31）。在 44 次妊娠中检测到抗磷脂抗体（aPL）（32%）。82 次妊娠使用了糖皮质激素（62%），20 次妊娠使用了他克莫司（15%）。有 24 例疾病活动（18%），但无 RD 相关死亡。我们记录了 112 例活产、6 例流产、8 例流产和 6 例死胎。与 GOP 相比，RDs 孕妇的剖宫产率（30% vs 15%）和早产率（21% vs 14%）更高。SLE 和 APS 的中位（四分位距）出生体重低于 GOP（分别为 2591[2231-2958]g、2600[2276-2920]g 和 2950[2650-3250]g）。SLE 孕妇中，低补体水平与母体并发症风险相关（比值比[95%CI]；3.9[1.0-14.9]，=0.046），抗-DNA 抗体阳性与胎儿并发症风险显著相关（比值比[95%CI]；3.5[1.1-11.2]，=0.036）。APS 孕妇中，年龄大于 35 岁和疾病持续时间大于 9 年（分别为 7.4[1.3-40.8]，=0.021 和 11.16[1.1-118.8]，=0.046）与胎儿并发症风险相关。
RDs 孕妇发生母体并发症和不良新生儿结局的风险增加，提示应密切监测这些妊娠。
