Department of Obstetrics, State University of Rio de Janeiro, Brazil.
GlaxoSmithKline Immunology and Inflammation Upper Providence, PA, USA.
Clin Exp Rheumatol. 2021 Sep-Oct;39(5):1043-1048. doi: 10.55563/clinexprheumatol/xspect. Epub 2020 Oct 18.
To analyse maternal variables associated with occurrence of small for gestational age (SGA) newborns in pregnancies of women with systemic lupus erythematosus (SLE), considering clinical and laboratory characteristics prior to conception, during gestation and comorbidities.
Retrospective cohort study with SLE pregnant patients and singleton deliveries after 22 weeks. SGA newborn was defined as birth weight below 10th percentile and SLE activity at conception and during gestation was measured using the SLE Pregnancy Disease Activity Index (SLEPDAI). Univariate analysis was employed to evaluate individual influence of demographic and clinical variables on the SGA newborn outcome, while variables with p<0.20 were included in multivariate regression.
Among 151 pregnancies, 28 (18.5%) had SGA newborns. History of proliferative nephritis (RR=3.84, CI 1.63-9.3) and positivity for anti-RNP and anti-Sm antibodies (RR=2.67, CI 1.11-6.43; 2.78, CI 1.44-5.32) were more frequent in the study group. Active proliferative nephritis at conception (RR=3.29, CI 1.75-6.18) and during gestation (RR=3.63, CI 1.97-6.71), as well as complement C3 consumption (RR=2.70, CI 1.09-6.67) and venous pulse therapy with methylprednisolone (RR=20.3, CI 2.18-190), were also associated with SGA newborns, the latter being independently associated in multivariate regression. Adverse perinatal outcomes, such as stillbirths (4.3 times) and neonatal intensive care unit admissions (3.2 times), were more frequent among SGA infants.
Active proliferative lupus nephritis during pregnancy was associated with SGA newborns, while its treatment with venous pulse therapy with methylprednisolone may play a significant role in this context. Presence of previous proliferative nephritis, SLEPDAI ≥4, C3 consumption and presence of anti-RNP and anti-Sm antibodies were additional variables associated with SGA newborns in this population.
分析与患有系统性红斑狼疮（SLE）的女性妊娠期间发生胎儿生长受限（SGA）新生儿相关的母体变量，同时考虑妊娠前、妊娠期间以及合并症的临床和实验室特征。
这是一项回顾性队列研究，纳入了 SLE 孕妇及其单胎妊娠 22 周后的分娩。SGA 新生儿定义为出生体重低于第 10 百分位数，妊娠前和妊娠期间的 SLE 活动度使用 SLE 妊娠疾病活动指数（SLEPDAI）进行测量。采用单因素分析评估人口统计学和临床变量对 SGA 新生儿结局的个体影响，而具有 p<0.20 的变量将被纳入多变量回归。
在 151 例妊娠中，有 28 例（18.5%）新生儿为 SGA。研究组中更常见有增殖性肾炎病史（RR=3.84，95%CI 1.63-9.3）和抗 RNP 抗体与抗 Sm 抗体阳性（RR=2.67，95%CI 1.11-6.43；2.78，95%CI 1.44-5.32）。妊娠前（RR=3.29，95%CI 1.75-6.18）和妊娠期间（RR=3.63，95%CI 1.97-6.71）存在活动期增殖性狼疮肾炎、补体 C3 消耗（RR=2.70，95%CI 1.09-6.67）以及静脉脉冲疗法用甲泼尼龙（RR=20.3，95%CI 2.18-190）与 SGA 新生儿有关，后者在多变量回归中独立相关。SGA 新生儿的不良围产期结局（如死胎（4.3 倍）和新生儿重症监护病房入院（3.2 倍））更为常见。
妊娠期间活动期增殖性狼疮肾炎与 SGA 新生儿有关，而静脉脉冲疗法用甲泼尼龙治疗可能在这种情况下发挥重要作用。既往存在增殖性肾炎、SLEPDAI≥4、C3 消耗以及抗 RNP 抗体和抗 Sm 抗体阳性是该人群中与 SGA 新生儿相关的其他变量。
