Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Lupus. 2019 Oct;28(12):1417-1426. doi: 10.1177/0961203319877247. Epub 2019 Sep 24.
The objective of this article is to describe maternal and perinatal outcomes in women with systemic lupus erythematosus (SLE) followed in a high-risk prenatal outpatient clinic at a referral center.
This observational study included pregnant women with SLE who underwent prenatal follow-up and childbirth at the Women's Hospital, University of Campinas, from January 2012 to January 2018. All women were followed according to the institution's protocol for pregnant women with SLE. They were subdivided into two groups according to the presence of disease activity during the preconception and gestation periods, and evaluated according to the Systemic Lupus Erythematosus Disease Activity Index and Systemic Lupus Erythematosus Pregnancy Disease Activity Index scales. Data were retrieved from patients' medical records. Chi-square, Fisher exact and Mann-Whitney tests and multivariable analyses were performed. Statistical significance level was 5% ( < .05).
A total of 125 cases were initially included; those who were lost to follow-up or gave birth at another hospital were further excluded, with 102 pregnancies (of 95 women) remaining. The mean age of the women was 27.7 years (SD 5.44), and 48% were in their first gestation. The average duration of disease was 6.79 years (SD 5.38), with 92.1% receiving SLE-specific therapy. SLE flare occurred in 8.9% during the preconception period and 23.5% during gestation. Preterm premature rupture of membranes (16.6%), preeclampsia or eclampsia (15.6%) and preterm labor (12.7%) were the most frequent complications. The mean gestational age at birth was 34.4 weeks (SD 5.9); the preterm birth rate was 46.8%, the low birth weight rate was 35.1%, and intensive neonatal care admission was 40.4%. Four fetal deaths and one maternal death occurred, all of them in the group with SLE flares. Multivariable logistic regression analysis showed that preconception lupus activity had a six-fold increased rate of gestational loss (odds ratio (OR): 6.14 (95% confidence interval (CI) 1.26-29.99)), and lupus activity during pregnancy had a five-fold increased rate of prematurity at less than 34 weeks (OR: 5.02 (95% CI: 1.90-13.30)).
Despite the low percentages of women with pregestational and pregnancy-active disease, we found high incidences of maternal and perinatal complications. Preconception SLE activity increased gestational loss, and SLE activity during pregnancy increased prematurity. Effective immunosuppressive therapy was able to decrease clinical and laboratory activity of SLE; however, unfavorable perinatal outcomes still occurred, even when lupus activity was under control. Pregnancy in women with SLE is always a challenge.
本文旨在描述在转诊中心高危产前门诊就诊的系统性红斑狼疮（SLE）女性的母婴围产期结局。
本观察性研究纳入了 2012 年 1 月至 2018 年 1 月在坎皮纳斯大学妇女医院接受产前随访和分娩的 SLE 孕妇。所有女性均根据机构的 SLE 孕妇治疗方案进行随访。根据孕前和孕期疾病活动情况将她们分为两组，并根据系统性红斑狼疮疾病活动指数和系统性红斑狼疮妊娠疾病活动指数量表进行评估。数据取自患者病历。采用卡方检验、Fisher 确切检验和曼-惠特尼检验以及多变量分析。统计显著性水平为 5%（ < .05）。
共纳入 125 例患者；随访丢失或在另一家医院分娩的患者被进一步排除，最终有 102 例（95 例）妊娠。女性的平均年龄为 27.7 岁（标准差 5.44），48%处于首次妊娠。疾病平均病程为 6.79 年（标准差 5.38），92.1%接受了 SLE 特异性治疗。孕前 SLE 发作率为 8.9%，孕期为 23.5%。最常见的并发症是早产胎膜早破（16.6%）、子痫前期或子痫（15.6%）和早产（12.7%）。出生时的平均胎龄为 34.4 周（标准差 5.9）；早产率为 46.8%，低出生体重率为 35.1%，新生儿重症监护入院率为 40.4%。有 4 例胎儿死亡和 1 例母亲死亡，均发生在 SLE 发作组。多变量 logistic 回归分析显示，孕前狼疮活动使妊娠丢失风险增加 6 倍（比值比（OR）：6.14（95%置信区间（CI）1.26-29.99）），而孕期狼疮活动使妊娠不足 34 周的早产风险增加 5 倍（OR：5.02（95%CI：1.90-13.30））。
尽管孕前和孕期疾病活动的女性比例较低，但我们发现母婴并发症发生率较高。孕前 SLE 活动增加了妊娠丢失，孕期 SLE 活动增加了早产。有效的免疫抑制治疗能够降低 SLE 的临床和实验室活动，但即使狼疮活动得到控制，不良的围产期结局仍会发生。SLE 孕妇的妊娠始终是一个挑战。
