Saleh Muna, Sjöwall Christopher, Strevens Helena, Jönsen Andreas, Bengtsson Anders A, Compagno Michele
Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, SE-581 85 Linköping, Sweden.
Department of Clinical Sciences Lund, Department of Obstetrics and Gynaecology, Lund University, SE-222 42 Lund, Sweden.
J Clin Med. 2020 Aug 11;9(8):2598. doi: 10.3390/jcm9082598.
While the management of pregnant patients with systemic lupus erythematosus (SLE) has improved over the last decades, the risk of maternal, foetal, and neonatal complications is still substantial. We evaluated the occurrence of adverse pregnancy outcomes (APO) occurring in 2002-2018 among patients with SLE from the catchment area of the Department of Rheumatology in Lund, Sweden. Longitudinal clinical and laboratory data were collected and analysed. Results were stratified according to the sequence of conception. We investigated a total of 59 pregnancies in 28 patients. Prior lupus nephritis was the clinical feature that, in a multivariable regression analysis, displayed the strongest association with APO overall (OR 6.0, = 0.02). SLE combined with antiphospholipid syndrome (APS) was associated with the risk of miscarriage (OR 3.3, = 0.04). The positivity of multiple antiphospholipid antibodies (aPL) was associated with APO overall (OR 3.3, = 0.05). IgG anti-cardiolipin during pregnancy resulted in a higher risk of preterm delivery (OR 6.8, = 0.03). Hypocomplementaemia was associated with several APO, but only in the first pregnancies. We conclude that, despite the close follow-up provided, a majority of pregnancies resulted in ≥1 APO, but a few of them were severe. Our study confirms the importance of previous lupus nephritis as a main risk factor for APO in patients with SLE.
尽管在过去几十年中，系统性红斑狼疮（SLE）孕妇的管理已有改善，但孕产妇、胎儿及新生儿并发症的风险仍然很大。我们评估了2002年至2018年期间瑞典隆德风湿病学系辖区内SLE患者中不良妊娠结局（APO）的发生情况。收集并分析了纵向临床和实验室数据。结果根据受孕顺序进行分层。我们共调查了28例患者的59次妊娠。在多变量回归分析中，既往狼疮性肾炎是与总体APO关联最强的临床特征（OR 6.0， = 0.02）。SLE合并抗磷脂综合征（APS）与流产风险相关（OR 3.3， = 0.04）。多种抗磷脂抗体（aPL）阳性与总体APO相关（OR 3.3， = 0.05）。孕期IgG抗心磷脂抗体导致早产风险更高（OR 6.8， = 0.03）。补体低下与多种APO相关，但仅在首次妊娠中如此。我们得出结论，尽管进行了密切随访，但大多数妊娠导致了≥1次APO，不过其中少数较为严重。我们的研究证实了既往狼疮性肾炎作为SLE患者APO主要危险因素的重要性。
