Service de Médecine Interne, Centre de Référence Maladies Autoimmunes et Systémiques Rares Île de France, APHP Hôpital Cochin, Paris, France.
Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy.
Rheumatology (Oxford). 2022 Aug 30;61(9):3657-3666. doi: 10.1093/rheumatology/keab943.
The specific roles of remission status, lupus low disease activity state (LLDAS), and damage accrual on the prognosis of pregnancies in women with SLE are unknown. We analysed their impact on maternal flares and adverse pregnancy outcomes (APOs).
We evaluated all women (≥18 years) with SLE enrolled in the prospective GR2 study with an ongoing singleton pregnancy at 12 weeks (one pregnancy/woman). Several sets of criteria were used to define remission, disease activity and damage. APOs included: foetal/neonatal death, placental insufficiency with preterm delivery and small-for-gestational-age birth weight. First trimester maternal and disease features were tested as predictors of maternal flares and APOs.
The study included 238 women (98.3% on hydroxychloroquine (HCQ)) with 230 live births. Thirty-five (14.7%) patients had at least one flare during the second/third trimester. At least one APOs occurred in 34 (14.3%) women. Hypocomplementemia in the first trimester was the only factor associated with maternal flares later in pregnancy (P=0.02), while several factors were associated with APOs. In the logistic regression models, damage by SLICC-Damage Index [odds ratio (OR) 1.8, 95% CI: 1.1, 2.9 for model 1 and OR 1.7, 95% CI: 1.1, 2.8 for model 2] and lupus anticoagulant (LA, OR 4.2, 95% CI: 1.8, 9.7 for model 1; OR 3.7, 95% CI: 1.6, 8.7 for model 2) were significantly associated with APOs.
LA and damage at conception were predictors of APOs, and hypocomplementemia in the first trimester was associated with maternal flares later in pregnancy in this cohort of pregnant patients mostly with well-controlled SLE treated with HCQ.
ClinicalTrials.gov, https://clinicaltrials.gov, NCT02450396.
缓解状态、狼疮低疾病活动状态（LLDAS）和累积损伤在系统性红斑狼疮（SLE）女性妊娠预后中的具体作用尚不清楚。我们分析了它们对母亲病情加重和不良妊娠结局（APO）的影响。
我们评估了所有在第 12 周（每位女性一次妊娠）正在进行单胎妊娠的、纳入前瞻性 GR2 研究的年龄≥18 岁的 SLE 女性（≥18 岁）（每位女性一次妊娠）。使用了多套标准来定义缓解、疾病活动度和损伤。APO 包括胎儿/新生儿死亡、早产伴胎盘功能不全和小于胎龄儿出生体重。第一孕期的母体和疾病特征被检测为预测母亲病情加重和 APO 的指标。
该研究纳入了 238 名（98.3%服用羟氯喹（HCQ））有 230 例活产的女性。35 名（14.7%）患者在第二/第三孕期至少有一次病情加重。34 名（14.3%）女性至少发生了一次 APO。第一孕期低补体血症是与妊娠后期母亲病情加重相关的唯一因素（P=0.02），而几个因素与 APO 相关。在逻辑回归模型中，SLICC-Damage Index 损伤[比值比（OR）1.8，95%可信区间（CI）：1.1，2.9，模型 1；OR 1.7，95%CI：1.1，2.8，模型 2]和狼疮抗凝剂（LA，OR 4.2，95%CI：1.8，9.7，模型 1；OR 3.7，95%CI：1.6，8.7，模型 2）与 APO 显著相关。
LA 和妊娠时的损伤是 APO 的预测因素，而第一孕期的低补体血症与该队列中接受 HCQ 治疗、病情得到较好控制的妊娠患者妊娠后期的母亲病情加重有关。
ClinicalTrials.gov，https://clinicaltrials.gov，NCT02450396。
