自身免疫性风湿病妇女的早产表型：基于人群的队列研究。
Preterm birth phenotypes in women with autoimmune rheumatic diseases: a population-based cohort study.
机构信息
Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
March of Dimes Prematurity Research Center at Stanford University School of Medicine, Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California, USA.
出版信息
BJOG. 2020 Jan;127(1):70-78. doi: 10.1111/1471-0528.15970. Epub 2019 Oct 31.
OBJECTIVE
To investigate preterm birth (PTB) phenotypes in women with different autoimmune rheumatic diseases in a large population-based cohort.
DESIGN
Retrospective cohort study.
SETTING
California, USA.
POPULATION
All live singleton births in California between 2007 and 2011 were analysed. Patients with autoimmune disease at delivery were identified by International Classification of Diseases, Ninth Revision , Clinical Modification (ICD-9-CM), codes for systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), polymyositis/dermatomyositis (DM/PM), and juvenile idiopathic arthritis (JIA).
METHODS
Maternally linked hospital and birth certificate records of 2 481 516 deliveries were assessed (SLE n = 2272, RA n = 1501, SSc n = 88, JIA n = 187, DM/PM n = 38). Multivariable Poisson regression models estimated the risk ratios (RRs) for different PTB phenotypes (relative to term deliveries) for each autoimmune disease compared with the general obstetric population, adjusting for maternal age, race/ethnicity, body mass index, smoking, education, payer, parity, and prenatal care.
MAIN OUTCOME MEASURES
Preterm birth (PTB) was assessed overall (20-36 weeks of gestation) and by subphenotype: preterm prelabour rupture of membranes (PPROM), spontaneous birth, or medically indicated PTB. The risk of PTB overall and for each phenotype was partitioned by gestational age: early (20-31 weeks of gestation) and late (32-36 weeks of gestation).
RESULTS
Risks for PTB were elevated for each autoimmune disease evaluated: SLE (RR 3.27, 95% CI 3.01-3.56), RA (RR 2.04, 95% CI 1.79-2.33), SSc (RR 3.74, 95% CI 2.51-5.58), JIA (RR 2.23, 95% CI 1.54-3.23), and DM/PM (RR 5.26, 95% CI 3.12-8.89). These elevated risks were observed for the majority of PTB phenotypes as well.
CONCLUSIONS
Women with systemic autoimmune diseases appear to have an elevated risk of various PTB phenotypes. Therefore, preconception counselling and close monitoring during pregnancy is crucial.
TWEETABLE ABSTRACT
This study found that women with systemic autoimmune diseases have an elevated risk of preterm birth phenotypes.
目的
在一个大型基于人群的队列中，研究不同自身免疫性风湿病患者的早产（PTB）表型。
设计
回顾性队列研究。
地点
美国加利福尼亚州。
人群
分析了 2007 年至 2011 年间加利福尼亚州所有活单胎分娩。通过国际疾病分类，第九修订版，临床修正（ICD-9-CM）的代码识别分娩时患有自身免疫性疾病的患者，用于系统性红斑狼疮（SLE）、系统性硬化症（SSc）、类风湿关节炎（RA）、多发性肌炎/皮肌炎（DM/PM）和幼年特发性关节炎（JIA）。
方法
评估了 2481516 次分娩的母婴链接医院和出生证明记录（SLE n=2272、RA n=1501、SSc n=88、JIA n=187、DM/PM n=38）。多变量泊松回归模型估计了与普通产科人群相比，每种自身免疫性疾病的不同 PTB 表型（相对于足月分娩）的风险比（RR），并调整了母亲年龄、种族/民族、体重指数、吸烟、教育程度、付款人、产次和产前保健。
主要观察结果
总体评估早产（PTB）（20-36 周妊娠）和亚表型：早产胎膜早破（PPROM）、自发性分娩或医学指征性早产。根据妊娠年龄对总体和每种表型的 PTB 风险进行了划分：早期（20-31 周妊娠）和晚期（32-36 周妊娠）。
结果
评估的每种自身免疫性疾病的 PTB 风险均升高：SLE（RR 3.27，95%CI 3.01-3.56）、RA（RR 2.04，95%CI 1.79-2.33）、SSc（RR 3.74，95%CI 2.51-5.58）、JIA（RR 2.23，95%CI 1.54-3.23）和 DM/PM（RR 5.26，95%CI 3.12-8.89）。同样，这些风险升高也见于大多数 PTB 表型。
结论
患有系统性自身免疫性疾病的女性似乎有各种 PTB 表型的风险增加。因此，孕前咨询和妊娠期间的密切监测至关重要。
推文摘要
本研究发现，患有系统性自身免疫性疾病的女性发生早产表型的风险增加。
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