S.A.M. Gernaat, MSc, PhD, E.V. Arkema, ScD, SM, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
J.F. Simard, ScD, SM, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden, and Division of Immunology and Rheumatology, Department of Medicine, Stanford School of Medicine, and Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, California, USA.
J Rheumatol. 2022 May;49(5):465-469. doi: 10.3899/jrheum.210087. Epub 2021 Dec 1.
To investigate the risk of gestational diabetes mellitus (GDM) associated with systemic lupus erythematosus (SLE) by comparing pregnancies in women with SLE to general population controls.
We identified singleton pregnancies among women with SLE and general population controls in the Swedish Medical Birth Register (MBR; 2006-2016), sampled from the population-based Swedish Lupus Linkage (SLINK) cohort (1987-2012). SLE was defined by ≥ 2 International Classification of Diseases (ICD)-coded visits in the National Patient Register (NPR) and MBR, with ≥ 1 visit before pregnancy. GDM was defined by ≥ 1 ICD-coded visit in the NPR or MBR. Glucocorticoid (GC) and hydroxychloroquine (HCQ) dispensations within 6 months before and during pregnancy were identified in the Prescribed Drug Register. Risk ratios (RRs) and 95% CIs of GDM associated with SLE were estimated using modified Poisson regression models, stratified by parity and adjusted for maternal age at delivery, year of birth, and obesity.
We identified 695 SLE pregnancies including 18 (2.6%) with GDM and 4644 non-SLE pregnancies including 65 (1.4%) with GDM. Adjusted RRs of GDM associated with SLE were 1.11 (95% CI 0.38-3.27) for first deliveries and 2.03 (95% CI 1.21-3.40) for all deliveries. Among SLE pregnancies, GDM occurred in 7/306 (2.3%) with ≥ 1 GC before and/or during pregnancy, 11/389 (2.8%) without GC, 7/287 (2.4%) with ≥ 1 HCQ before and/or during pregnancy, and in 11/408 (2.7%) without HCQ.
When looking at all deliveries, SLE was associated with a 2-fold higher risk of GDM. GDM occurrence did not differ by GC or HCQ.
通过比较系统性红斑狼疮（SLE）患者的妊娠与一般人群对照，探讨妊娠合并糖尿病（GDM）的风险。
我们在瑞典医疗出生登记处（MBR；2006-2016 年）中确定了 SLE 患者和一般人群对照的单胎妊娠，并从基于人群的瑞典狼疮链接（SLINK）队列（1987-2012 年）中抽取样本。SLE 通过国家患者登记处（NPR）和 MBR 中≥2 次国际疾病分类（ICD）编码就诊来定义，且至少有 1 次就诊在妊娠前。GDM 通过 NPR 或 MBR 中≥1 次 ICD 编码就诊来定义。在妊娠前和妊娠期间的 6 个月内，通过处方药物登记处确定糖皮质激素（GC）和羟氯喹（HCQ）的配给情况。使用修正泊松回归模型估计与 SLE 相关的 GDM 的风险比（RR）和 95%置信区间（CI），按产次和调整分娩时母亲年龄、出生年份和肥胖分层。
我们共确定了 695 例 SLE 妊娠，其中 18 例（2.6%）患有 GDM，4644 例非 SLE 妊娠，其中 65 例（1.4%）患有 GDM。SLE 与 GDM 相关的调整 RR 分别为首次分娩时的 1.11（95%CI 0.38-3.27）和所有分娩时的 2.03（95%CI 1.21-3.40）。在 SLE 妊娠中，11/389（2.8%）无 GC，7/287（2.4%）在妊娠前和/或妊娠期间有≥1 次 GC，11/408（2.7%）无 HCQ，在妊娠前和/或妊娠期间有≥1 次 HCQ，7/287（2.4%）。
在所有分娩中，SLE 与 GDM 的风险增加 2 倍相关。GC 或 HCQ 的使用与 GDM 的发生无关。
