Rheumatology Department, Cochin Hospital (AP-HP), Paris, France.
Lille University, University Hospital Center of Lille, Lille, France.
Rheumatology (Oxford). 2022 Apr 11;61(4):1314-1327. doi: 10.1093/rheumatology/keab589.
The aim of this study was to determine the impact of SpA and its treatments on fertility and pregnancy outcomes, as well as the impact of pregnancy on disease activity.
A systematic review and meta-analyses were performed, including studies in women with SpA [axial (axSpA) and peripheral SpA, including PsA]. The heterogeneity between studies was quantified (I2), and in the case of substantial heterogeneity, the results were reported in a narrative review.
Of 4397 eligible studies, 21 articles were included, assessing a total of 3566 patients and 3718 pregnancies, compared with 42 264 controls. There is a lack of data on fertility in the literature. We found an increased risk of preterm birth [pooled odds ratio (OR) 1.64 (1.15-2.33), I2 =24% in axSpA and 1.62 (1.23-2.15), I2 =0.0% in PsA], small for gestational age [pooled OR 2.05 (1.09-3.89), I2 =5.8% in axSpA], preeclampsia [pooled OR 1.59 (1.11-2.27], I2 =0% in axSpA] and caesarean section [pooled OR 1.70 (1.44-2.00), I2 =19.9% in axSpA and 1.71 (1.14-2.55), I2 =74.3% in PsA], without any other unfavourable pregnancy outcome. Further analysis showed a significantly higher risk of elective caesarean section [pooled OR 2.64 (1.92-3.62), I2 =0.0% in axSpA and 1.47 [1.15-1.88], I2 =0,0% in PsA), without increased risk of emergency caesarean section in PsA. During pregnancy, there appears to be a tendency for unchanged or worsened disease activity in axSpA and unchanged or improved disease activity in PsA. Both conditions tend to flare in the postpartum period.
SpA seems to be associated with an increased risk of preterm birth, small for gestational age, preeclampsia, and caesarean section.
本研究旨在确定强直性脊柱炎（SpA）及其治疗对生育和妊娠结局的影响，以及妊娠对疾病活动的影响。
进行了系统评价和荟萃分析，包括患有 SpA（中轴型 SpA[axSpA]和外周型 SpA，包括银屑病关节炎[PsA]）的女性的研究。对研究间的异质性进行了量化（I2），如果存在显著异质性，则以叙述性综述的形式报告结果。
在 4397 篇合格的研究中，纳入了 21 篇文章，评估了总共 3566 名患者和 3718 例妊娠，与 42264 名对照相比。文献中缺乏关于生育力的数据。我们发现早产的风险增加[汇总优势比（OR）1.64（1.15-2.33），I2=24%在 axSpA 和 1.62（1.23-2.15），I2=0.0%在 PsA]、小于胎龄儿[汇总 OR 2.05（1.09-3.89），I2=5.8%在 axSpA]、子痫前期[汇总 OR 1.59（1.11-2.27），I2=0%在 axSpA]和剖宫产[汇总 OR 1.70（1.44-2.00），I2=19.9%在 axSpA 和 1.71（1.14-2.55），I2=74.3%在 PsA]，没有其他不良妊娠结局。进一步分析显示，选择性剖宫产的风险显著增加[汇总 OR 2.64（1.92-3.62），I2=0.0%在 axSpA 和 1.47（1.15-1.88），I2=0.0%在 PsA]，而 PsA 中紧急剖宫产的风险没有增加。在妊娠期间，axSpA 似乎存在疾病活动不变或恶化的趋势，而 PsA 则存在疾病活动不变或改善的趋势。这两种情况在产后期间都有加重的趋势。
SpA 似乎与早产、小于胎龄儿、子痫前期和剖宫产的风险增加有关。
