Department of Rheumatology, 8964University College London Hospital NHS Foundation Trust, London, UK.
UCL Medical School, 4919University College London, London, UK.
Lupus. 2022 Jan;31(1):5-18. doi: 10.1177/09612033211061850. Epub 2021 Dec 6.
Not all patients fulfil criteria for specific autoimmune rheumatic diseases (ARDs) and are then defined as having non-criteria (nc)ARD. It is uncertain whether well-recognised associations with adverse pregnancy outcomes in patients with criteria ARD also exist in patients with ncARD or undifferentiated connective tissue disease (UCTD). Therefore, we undertook a systematic review of the prevalence of adverse pregnancy outcomes in various ncARD and UCTD compared with criteria ARD to identify whether there are increased risks and to examine for any benefits of treatment.
This study was conducted in accordance with the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. A systematic literature review was performed using online databases including Medline and PubMed from inception to the beginning of April 2021 using appropriate keywords for various ARD and pregnancy outcomes.
After screening 665 articles, 36 articles were chosen for full text review and 15 selected for final analysis. There were eight studies of nc antiphospholipid syndrome (APS) of more than 7000 pregnancies and seven studies of UCTD of more than 1000 pregnancies. No studies of any other ncARD in pregnancy were identified. We found that patients with either ncAPS or UCTD seem to have an increased burden of poor pregnancy outcomes compared with the general population. Despite the heterogeneity and poor quality of the studies, we also noted that ncAPS and criteria APS patients may have similar rates of obstetric complications with standard and/or non-standard APS treatment regimens.
Our findings of increased risks of poor pregnancy outcomes in patients with ncAPS or UCTD will be helpful for pre-pregnancy counselling and management of these patients in pregnancy and support their referral to specialist obstetric-rheumatology and obstetric-haematology clinics.
并非所有患者都符合特定自身免疫性风湿病 (ARD) 的标准，因此被定义为患有非标准 (nc)ARD。目前尚不确定在符合标准 ARD 的患者中，与不良妊娠结局相关的公认关联是否也存在于 ncARD 或未分化结缔组织病 (UCTD) 患者中。因此，我们对各种 ncARD 和 UCTD 与标准 ARD 相比不良妊娠结局的患病率进行了系统回顾，以确定是否存在风险增加，并检查治疗是否有任何益处。
本研究按照系统评价和荟萃分析的首选报告项目 (PRISMA) 标准进行。使用 Medline 和 PubMed 等在线数据库，从开始到 2021 年 4 月初，使用适用于各种 ARD 和妊娠结局的适当关键词进行了系统文献检索。
经过筛选 665 篇文章，有 36 篇文章进行了全文审查，15 篇文章入选进行最终分析。有 8 项 nc 抗磷脂综合征 (APS) 超过 7000 例妊娠的研究和 7 项 UCTD 超过 1000 例妊娠的研究。没有发现任何其他 ncARD 在妊娠中的研究。我们发现，ncAPS 或 UCTD 患者与普通人群相比，妊娠不良结局的负担似乎更大。尽管研究存在异质性和质量较差，但我们还注意到，ncAPS 和标准 APS 患者可能具有相似的产科并发症发生率，采用标准和/或非标准 APS 治疗方案。
我们发现 ncAPS 或 UCTD 患者不良妊娠结局风险增加的发现，将有助于对这些患者进行孕前咨询和妊娠管理，并支持将他们转介到妇产科风湿病学和妇产科血液病学专科诊所。
