Maguire Sinead, O'Dwyer Tom, Mockler David, O'Shea Finbar, Wilson Fiona
Department of Rheumatology, St James' Hospital, James' Street, Dublin, Ireland.
Independent Researcher, Dublin, Ireland.
Semin Arthritis Rheum. 2020 Dec;50(6):1269-1279. doi: 10.1016/j.semarthrit.2020.08.011. Epub 2020 Aug 29.
Axial spondyloarthropathy (axSpA) is an inflammatory arthritis which affects the sacroiliac joints and the spine. Many females affected are of childbearing age. Studies on effects of pregnancy on axSpA disease activity and medication use have been limited, with divergent conclusions.
To review literature on axSpA in pregnancy to determine the effect of disease on pregnancy outcomes.
A systematic review of case-control trials, observational studies, cross sectional studies and case series (n>5) on axSpA in pregnancy. EMBASE, Medline (OVID), CINAHL, Maternity and Infant Care (MIDIRS online), and Web of Science were searched for keywords. Two reviewers reviewed articles to determine suitability for inclusion. The Newcastle Ottawa Scale was used to assess risk of bias. Data extraction was performed using a standardized template to streamline data to allow comparison and meta-analysis.
Search strategy returned 884 records, 130 full text articles were assessed for eligibility. Eighteen studies with a total of 3,166 axSpA participants were eligible for inclusion. There was an increased prevalence of pre-eclampsia (OR 1.3, 95% CI 0.92-1.82) and IUGR (OR 1.17, 95% CI 0.26-5.17) and a statistically significant increase in cesarean sections (OR 1.85, 95% CI 1.46-2.30) in axSpA females, with an especially high prevalence of elective cesarean sections (OR 2.26, 95% CI 1.74, 2.93). There was a trend towards increased prevalence of fetal complications in axSpA pregnancies (LBW OR 1.47, 95% CI 0.98-2.21; SGA OR1.66, 95% CI 0.93-2.95; congenital abnormalities OR 1.34, 95% CI0.63-1.24; NICU admissions OR 1.55, 95% CI 0.96-2.51) which did not reach significance.
AxSpA females have an increased prevalence of cesarean sections compared to the general population. There is a trend towards increased prevalence of pre-eclampsia, IUGR and certain fetal complications. Ongoing development of national registries could help to better understand axSpA in pregnancy.
轴性脊柱关节炎（axSpA）是一种影响骶髂关节和脊柱的炎性关节炎。许多受影响的女性处于生育年龄。关于妊娠对axSpA疾病活动和药物使用影响的研究有限，结论也存在分歧。
回顾关于妊娠期间axSpA的文献，以确定该疾病对妊娠结局的影响。
对关于妊娠期间axSpA的病例对照试验、观察性研究、横断面研究和病例系列（n>5）进行系统评价。在EMBASE、Medline（OVID）、CINAHL、母婴护理（MIDIRS在线）和科学网中搜索关键词。两名评审员对文章进行评审以确定是否适合纳入。使用纽卡斯尔渥太华量表评估偏倚风险。使用标准化模板进行数据提取，以简化数据以便进行比较和荟萃分析。
检索策略返回884条记录，对130篇全文文章进行了资格评估。18项研究共3166名axSpA参与者符合纳入标准。axSpA女性患先兆子痫（OR 1.3，95%CI 0.92-1.82）和胎儿生长受限（OR 1.17，95%CI 0.26-5.17）的患病率增加，剖宫产率有统计学显著增加（OR 1.85，95%CI 1.46-2.30），其中择期剖宫产率尤其高（OR 2.26，95%CI 1.74，2.93）。axSpA妊娠中胎儿并发症的患病率有增加趋势（低体重儿OR 1.47，95%CI 0.98-2.21；小于胎龄儿OR1.66，95%CI 0.93-2.95；先天性异常OR 1.3,4，95%CI0.63-1.24；新生儿重症监护病房入院率OR 1.55，95%CI 0.96-2.51），但未达到显著水平。
与普通人群相比，axSpA女性剖宫产率增加。先兆子痫、胎儿生长受限和某些胎儿并发症的患病率有增加趋势。国家登记系统的持续发展有助于更好地了解妊娠期间的axSpA。
