Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung 407, Taiwan.
Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
Semin Arthritis Rheum. 2020 Jun;50(3):451-457. doi: 10.1016/j.semarthrit.2020.01.014. Epub 2020 Feb 4.
Systemic lupus erythematosus (SLE) is an autoimmune disease that develops mainly in women of reproductive age. We aimed to explore the risk of pregnancy complications in Asian patients with SLE.
From January 2005 to December 2014, we conducted a nationwide case-control study, using Taiwan's National Health Insurance Research Database. Obstetric complications and perinatal outcomes in SLE patients were compared with those without SLE.
2059 SLE offspring and 8236 age-matched, maternal healthy controls were enrolled. We found increased obstetric and perinatal complications in SLE population compared with healthy controls. SLE patients exhibited increased risk of preeclampsia/eclampsia (8.98% vs.1.98%, odds ratio [OR]: 3.87, 95% confidence interval [95% CI]: 3.08-4.87, p<0.0001). Their offspring tended to have lower Apgar scores (<7) at both 1 min (10.7% vs. 2.58%, p<0.0001) and 5 min (4.25% vs. 1.17%, p<0.0001), as well as higher rates of intrauterine growth restriction (IUGR, 9.91% vs. 4.12%, OR: 2.24, 95% CI: 1.85-2.71, p<0.0001), preterm birth (23.70% vs 7.56%, OR: 3.00, 95% CI: 2.61-3.45, p<0.0001), and stillbirth (4.23% vs. 0.87%, OR: 3.59, 95% CI: 2.54-5.06, p<0.0001). The risks of preterm birth and stillbirth were markedly increased in SLE patients with concomitant preeclampsia/eclampsia or IUGR. Preterm birth of SLE patients was 14 gestational weeks earlier than that of healthy controls and the peak occurrence of stillbirth in SLE population was at 2030 gestational weeks.
Asian SLE patients exhibited increased risks of maternal complications and adverse birth outcomes. Frequent antenatal visits before 20 gestational weeks are recommended in high-risk SLE patients.
系统性红斑狼疮（SLE）是一种主要发生在育龄期女性中的自身免疫性疾病。本研究旨在探讨亚洲 SLE 患者妊娠并发症的风险。
我们进行了一项全国性的病例对照研究，纳入了 2005 年 1 月至 2014 年 12 月期间来自台湾全民健康保险研究数据库的患者。比较了 SLE 患者与无 SLE 患者的产科并发症和围产儿结局。
共纳入 2059 例 SLE 后代和 8236 名年龄匹配的、母亲健康的对照组。与健康对照组相比，SLE 人群的产科和围产儿并发症增加。SLE 患者发生子痫前期/子痫的风险增加（8.98% vs. 1.98%，比值比[OR]：3.87，95%置信区间[95%CI]：3.08-4.87，p<0.0001）。SLE 患者的后代在 1 分钟（10.7% vs. 2.58%，p<0.0001）和 5 分钟（4.25% vs. 1.17%，p<0.0001）时的 Apgar 评分较低，以及宫内生长受限（IUGR，9.91% vs. 4.12%，OR：2.24，95%CI：1.85-2.71，p<0.0001）、早产（23.70% vs. 7.56%，OR：3.00，95%CI：2.61-3.45，p<0.0001）和死胎（4.23% vs. 0.87%，OR：3.59，95%CI：2.54-5.06，p<0.0001）的发生率更高。SLE 患者合并子痫前期/子痫或 IUGR 时，早产和死胎的风险显著增加。SLE 患者的早产时间比健康对照组早 1-4 周，SLE 人群死胎的高峰发生在 20-30 周妊娠。
亚洲 SLE 患者发生母胎并发症和不良围产儿结局的风险增加。建议高危 SLE 患者在 20 周妊娠前进行频繁的产前检查。
