Bansal Sukriti, Okoye Ogochukwu, Rajora Nilum
Michael E. DeBakey Department of Surgery, Baylor College of Surgery, Houston; University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Internal Medicine, Faculty of Heath Sciences, Delta State University, Abraka, Nigeria.
Saudi J Kidney Dis Transpl. 2020 Jan-Feb;31(1):10-20. doi: 10.4103/1319-2442.279928.
Systemic lupus erythematosus (SLE) and lupus nephritis (LN) have a significant impact on the course of pregnancy, as well as on maternal and fetal outcomes. LN in pregnancy can increase the maternal risks of SLE flare, acute kidney injury, preeclampsia, and even death. It also affects fetal outcomes by the increased risk of intrauterine growth retardation, premature delivery, and fetal loss. Successful pregnancy outcomes have been well documented in the developed world, but less is known about patients in developing nations. We searched PubMed and Google scholar for all articles published from 1999 to 2016 in developing countries. Twelve of 13 studies were included excluding only one. All studies were independently reviewed. Most of the studies reported a significant association between high flare rates of LN and higher rates of disease flare. Higher rates of active disease at conception were associated with lower live birth rates. Similarly, high flare rates of LN were associated with higher rates of fetal loss. With regard to geographic trends, Indian studies reported lower overall live birth rates and higher rates of active disease at conception. Interestingly, lower rates of preeclampsia were also noted in Indian studies. Higher rates of flare were observed in other Asian studies, but not the Indian studies. Although LN and active SLE at conception are associated with poor fetal outcomes, better outcomes are possible with proper management, even in low-resource settings. More research is necessary to fully understand the relationships between active disease at conception or LN and flare rates, live birth rates, and fetal loss rates in developing countries.
系统性红斑狼疮（SLE）和狼疮性肾炎（LN）对妊娠过程以及母婴结局均有重大影响。妊娠合并LN会增加母亲发生SLE病情活动、急性肾损伤、先兆子痫甚至死亡的风险。它还会因增加胎儿宫内生长受限、早产和流产的风险而影响胎儿结局。在发达国家，成功的妊娠结局已有充分记录，但对于发展中国家的患者了解较少。我们在PubMed和谷歌学术上搜索了1999年至2016年在发展中国家发表的所有文章。13项研究中的12项被纳入，仅排除1项。所有研究均进行了独立评审。大多数研究报告称LN的高病情活动率与更高的疾病复发率之间存在显著关联。妊娠时活动性疾病发生率较高与较低的活产率相关。同样，LN的高病情活动率与较高的流产率相关。关于地理趋势，印度的研究报告总体活产率较低，妊娠时活动性疾病发生率较高。有趣的是，印度的研究中先兆子痫的发生率也较低。在其他亚洲研究中观察到较高的病情活动率，但印度的研究未观察到。尽管妊娠时LN和活动性SLE与不良胎儿结局相关，但即使在资源匮乏的环境中，通过适当管理也可能获得更好的结局。需要更多研究来全面了解发展中国家妊娠时活动性疾病或LN与病情活动率、活产率和流产率之间的关系。
