Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Department of Medical Biotechnologies, University of Siena, Siena, Italy.
Lupus Sci Med. 2022 Jun;9(1). doi: 10.1136/lupus-2022-000714.
It is still a matter of debate whether low-dose acetylsalicylic acid (LDASA) should be prescribed to all patients with SLE during pregnancy. This study aimed at investigating the impact of LDASA on pregnancy outcomes in patients with SLE without history of renal involvement and without antiphospholipid antibodies (aPL).
This is a retrospective analysis of prospectively monitored pregnancies at seven rheumatology centres. Previous/current renal involvement and aPL positivity were the exclusion criteria. Adverse pregnancy outcome (APO) is the composite outcome of the study and included proteinuric pre-eclampsia, preterm delivery <37 weeks, small-for-gestational age infant, low birth weight <2500 g, intrauterine growth restriction and intrauterine fetal death after 12 weeks of gestation of a morphologically normal fetus.
216 pregnancies in 187 patients were included; 82 pregnancies (38.0%) were exposed to LDASA treatment. No differences in terms of age at conception, disease duration, clinical manifestations, comorbidities and disease flare during pregnancy were observed between patients taking LDASA and those who did not take LDASA during pregnancy. APO was observed in 65 cases (30.1%), including 13 cases (6.1%) of pre-eclampsia. The incidence of all complications was similar in the two groups. However, it is interesting to note that pre-eclampsia had lower frequency in patients taking LDASA versus those not taking LDASA (2.4% vs 8.3%, p=0.14).
In pregnant patients with SLE without renal involvement and were aPL-negative, there is a low risk of severe obstetric complications, such as early pre-eclampsia. LDASA treatment does not provide a statistically significant advantage over these complications. However, a careful individual risk-benefit balance is warranted.
低剂量乙酰水杨酸（LDASA）是否应在妊娠期间用于所有 SLE 患者仍存在争议。本研究旨在调查无肾脏受累和抗磷脂抗体（aPL）病史的 SLE 患者使用 LDASA 对妊娠结局的影响。
这是对七个风湿病中心进行的前瞻性监测妊娠的回顾性分析。既往/当前的肾脏受累和 aPL 阳性是排除标准。不良妊娠结局（APO）是本研究的综合结局，包括蛋白尿子痫前期、早产<37 周、小于胎龄儿、低出生体重<2500g、宫内生长受限和妊娠 12 周后形态正常胎儿的宫内胎儿死亡。
纳入了 187 名患者的 216 例妊娠；82 例（38.0%）妊娠暴露于 LDASA 治疗。接受 LDASA 治疗和未接受 LDASA 治疗的患者在受孕年龄、疾病持续时间、临床表现、合并症和妊娠期间疾病发作方面无差异。65 例（30.1%）发生 APO，包括 13 例（6.1%）子痫前期。两组的所有并发症发生率相似。然而，有趣的是，子痫前期在接受 LDASA 治疗的患者中的发生率低于未接受 LDASA 治疗的患者（2.4%比 8.3%，p=0.14）。
在无肾脏受累和 aPL 阴性的 SLE 妊娠患者中，严重产科并发症（如早发性子痫前期）的风险较低。LDASA 治疗在这些并发症方面没有提供统计学上的显著优势。然而，需要谨慎权衡个体的风险效益比。
