Rheumatology Unit, Department of Clinical and Experimental Medicine, Pisa.
Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa.
Rheumatology (Oxford). 2020 Jun 1;59(6):1335-1339. doi: 10.1093/rheumatology/kez440.
UCTD is a systemic autoimmune condition that fails to fulfil the criteria for a definite CTD. Given that there are a lack of studies on links between pregnancy and UCTD, the purpose of this study was to evaluate the risk of disease flares or development of CTD in addition to the risk of adverse pregnancy outcomes in patients with UCTD.
This is a retrospective study using prospectively collected data for 100 pregnancies in 81 incidences of UCTD treated in a single referral centre.
A total of 11 pregnancies (11%) ended in miscarriage in the first trimester and the remaining 89 (89%) ended with a live birth. Thirteen patients (13%) flared during pregnancy or puerperium and three (3%) suffered major flares that led to the development of SLE with renal involvement. Obstetric complications occurred in 26 of the 89 successful pregnancies (29%), including 1 case (1%) of pre-eclampsia; in some cases, a single pregnancy was affected by more than one complication. There was a significant link between disease flare and both anti-dsDNA-positive antibodies at baseline (P < 0.01) and disease activity at the beginning of pregnancy (P < 0.01).
The impact on pregnancy in the study's cohort appears to be less serious in UCTD than in other CTDs. Nevertheless, disease flares and obstetric complications can represent a clinical challenge and clinical and serological disease activity would appear to represent important determinants of pregnancy outcomes. Pre-pregnancy counselling and planning as well as close monitoring during pregnancy is therefore essential.
UCTD 是一种系统性自身免疫性疾病，未能满足明确 CTD 的标准。鉴于目前关于妊娠与 UCTD 之间联系的研究较少，本研究旨在评估 UCTD 患者疾病加重或发展为 CTD 的风险，以及不良妊娠结局的风险。
这是一项回顾性研究，使用前瞻性收集的数据，对在一家转诊中心治疗的 81 例 UCTD 中的 100 例妊娠进行评估。
共有 11 例（11%）妊娠在孕早期流产，其余 89 例（89%）分娩活产儿。13 例（13%）患者在妊娠或产褥期加重，3 例（3%）发生严重加重，导致伴有肾脏受累的 SLE 发生。在 89 例成功妊娠中，26 例（29%）发生产科并发症，包括 1 例（1%）子痫前期；在某些情况下，单次妊娠受到一种以上并发症的影响。疾病加重与基线时的抗 dsDNA 阳性抗体（P < 0.01）和妊娠开始时的疾病活动（P < 0.01）之间存在显著关联。
与其他 CTD 相比，本研究队列中 UCTD 对妊娠的影响似乎较轻。然而，疾病加重和产科并发症可能构成临床挑战，临床和血清学疾病活动似乎是妊娠结局的重要决定因素。因此，妊娠前咨询和计划以及妊娠期间的密切监测至关重要。
