University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Obstetrics, Lundlaan 6, 3584 EA Utrecht, the Netherlands.
University Medical Center Utrecht, Department of Rheumatology and Clinical Immunology, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
Autoimmun Rev. 2021 Oct;20(10):102901. doi: 10.1016/j.autrev.2021.102901. Epub 2021 Jul 16.
To identify and assess the magnitude of effect of pregnancy outcome predictors in women with antiphospholipid syndrome (APS) by means of systematic review and meta-analysis.
PubMed and Embase were searched (13th June 2020) for studies reporting on pre-pregnancy risk factors of pregnancy outcomes in APS patients. Literature screening and data extraction were conducted by two reviewers independently, in a blinded standardized manner. Pooled univariate odds ratios (OR) were computed using a random effects model. Heterogeneity was assessed by I%.
The search yielded 3013 unique results; 27 records were included in this meta-analysis. Previous thrombosis was associated with a decreased live birth risk (OR 0.60, p < 0.01, I = 40%), increased neonatal mortality (OR 15.19, p < 0.01, I = 0%), an increased risk of antenatal or postpartum thrombosis (OR 6.26, p < 0.01, I = 0%) and an increased risk of delivering a small for gestational age neonate (SGA) (OR 2.60, p = 0.01, I = 0%). Patients with an APS laboratory category I (double or triple positivity) profile had a decreased live birth risk (OR 0.66, p < 0.01, I = 0%), an increased risk of SGA (OR 1.86, p = 0.01, I = 43%) and preterm birth (OR 1.35, p < 0.01, I = 49%). Triple positivity was associated with a decreased live birth risk (OR 0.33, p < 0.01, I = 68%), an increased risk of preeclampsia (OR 2.43, p = 0.02, I = 35%) and SGA (OR 2.47, p = 0.04, I = 61%). Patients with lupus anticoagulant positivity had an increased risk of preeclampsia (OR 2.10, p = 0.02, I = 48%), SGA (OR 1.78, p < 0.01, I = 0%) and preterm birth (OR 3.56, p = 0.01, I = 48%). Risk of bias assessment suggested considerable bias on study participation and statistical methods.
The results of this meta-analysis identified previous thrombosis, laboratory category I, triple positivity and lupus anticoagulant positivity as the most important predictors of adverse pregnancy outcomes. This up-to-date knowledge, can be used in preconception counseling and tailoring of obstetric care.
通过系统评价和荟萃分析，确定并评估抗磷脂综合征（APS）女性妊娠结局预测因素的作用大小。
检索 PubMed 和 Embase，查找报告 APS 患者妊娠前风险因素与妊娠结局的研究。两名审查员以盲法标准化的方式独立进行文献筛选和数据提取。使用随机效应模型计算汇总单变量比值比（OR）。使用 I²评估异质性。
搜索结果产生了 3013 个独特的结果；27 项记录纳入了本荟萃分析。既往血栓形成与活产风险降低相关（OR 0.60，p<0.01，I=40%）、新生儿死亡率增加（OR 15.19，p<0.01，I=0%）、产前或产后血栓形成风险增加（OR 6.26，p<0.01，I=0%）和胎儿生长受限（SGA）新生儿风险增加（OR 2.60，p=0.01，I=0%）。APS 实验室分类 I（双重或三重阳性）患者的活产风险降低（OR 0.66，p<0.01，I=0%）、SGA（OR 1.86，p=0.01，I=43%）和早产（OR 1.35，p<0.01，I=49%）风险增加。三重阳性与活产风险降低（OR 0.33，p<0.01，I=68%）、子痫前期（OR 2.43，p=0.02，I=35%）和 SGA（OR 2.47，p=0.04，I=61%）风险增加相关。狼疮抗凝物阳性患者子痫前期（OR 2.10，p=0.02，I=48%）、SGA（OR 1.78，p<0.01，I=0%）和早产（OR 3.56，p=0.01，I=48%）风险增加。偏倚风险评估表明研究参与和统计方法存在相当大的偏倚。
本荟萃分析的结果确定了既往血栓形成、实验室分类 I、三重阳性和狼疮抗凝物阳性是不良妊娠结局的最重要预测因素。这种最新知识可用于孕前咨询和产科护理的定制。
