Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
Rheumatology (Oxford). 2021 Dec 1;60(12):5610-5619. doi: 10.1093/rheumatology/keab155.
To determine whether disease remission or low disease activity state at the beginning of pregnancy in SLE patients is associated with better pregnancy outcome.
Pregnancies in SLE patients prospectively monitored by pregnancy clinics at four rheumatology centres were enrolled. Patient demographics and clinical information were collected at baseline (pregnancy visit before 8 weeks of gestation) including whether patients were in remission according to the Definition of Remission in SLE (DORIS) criteria and and/or Lupus Low Disease Activity State (LLDAS). Univariate and multivariate analysis were performed to determine predictors of disease flare and adverse pregnancy outcomes (APOs) including preeclampsia, preterm delivery, small for gestational age infant, intrauterine growth restriction and intrauterine fetal death.
A total of 347 pregnancies were observed in 281 SLE patients. Excluding early pregnancy losses, 212 pregnancies (69.7%) occurred in patients who were in remission at baseline, 33 (10.9%) in patients in LLDAS, and the remainder in active patients. Seventy-three flares (24%) were observed during pregnancy or puerperium, and 105 (34.5%) APOs occurred. Multivariate analysis revealed that patients in disease remission or taking HCQ were less likely to have disease flare, while a history of LN increased the risk. The risk of APOs was increased in patients with shorter disease duration, while being on HCQ resulted a protective variable. An almost significant association between complete remission and a decreased risk of APOs was observed.
Prenatal planning with a firm treat-to-target goal of disease remission is an important strategy to reduce the risk of disease flares and severe obstetric complications in SLE pregnancies.
确定系统性红斑狼疮（SLE）患者妊娠早期疾病缓解或低疾病活动状态是否与更好的妊娠结局相关。
前瞻性纳入在四家风湿病中心妊娠诊所监测的 SLE 患者妊娠。在妊娠前 8 周（妊娠就诊前）基线时收集患者的人口统计学和临床信息，包括根据系统性红斑狼疮缓解定义（DORIS）标准和/或狼疮低疾病活动状态（LLDAS）患者是否处于缓解状态。采用单变量和多变量分析来确定疾病复发和不良妊娠结局（APO）的预测因素，包括子痫前期、早产、小于胎龄儿、宫内生长受限和胎儿宫内死亡。
共观察到 281 例 SLE 患者的 347 次妊娠。排除早期妊娠丢失后，212 次妊娠（69.7%）发生在基线缓解的患者中，33 次妊娠（10.9%）发生在 LLDAS 患者中，其余患者处于活动期。妊娠或产褥期观察到 73 次复发（24%），105 次（34.5%）发生 APO。多变量分析显示，疾病缓解或服用羟氯喹的患者不太可能发生疾病复发，而狼疮肾炎病史会增加风险。疾病持续时间较短的患者发生 APO 的风险增加，而服用羟氯喹则是保护因素。完全缓解与 APO 风险降低之间存在显著关联。
制定以疾病缓解为目标的产前计划是减少 SLE 妊娠疾病复发和严重产科并发症风险的重要策略。
