Centre for Rheumatology, Department of Inflammation, Division of Medicine, University College London, London, UK.
Systemic Autoimmune Disease Unit, Department of Medicine, Vall d'Hebron University Hospital, Barcelona, Spain.
Rheumatology (Oxford). 2023 Feb 1;62(2):497-511. doi: 10.1093/rheumatology/keac417.
An increased risk of adverse maternal and foetal pregnancy complications (including pre-eclampsia, intrauterine growth restriction, and small for gestational age) is well described in women with autoimmune rheumatic disease (ARD) compared with the general population (GenPop). It is less clear, however, whether this risk of adverse pregnancy outcome (APO) also exists in women with 'preclinical ARD' (pre-ARD) before they are diagnosed with an ARD many years post-partum. Therefore, we have undertaken a systematic review of the available evidence on APO in patients who subsequently were diagnosed with a rheumatic disease to identify whether there is an increased risk in pre-ARD.
The present study was reported 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 the online PubMed database. Pre-SLE and pre-RA patients were defined as those who, over the subsequent years, developed SLE or RA according to international classification criteria.
A total of 176 articles were screened, and 27 original articles were selected for final analysis. Pre-RA was the most studied group, with 15 studies and a total of >1600 pregnancies, and pre-SLE was the second-most studied pre-ARD in pregnancy, with 14 studies and a total of >1000 pregnancies. We found that patients who subsequently developed SLE had an increased burden of poor pregnancy outcomes compared with pregnant women from the GenPop, but fewer APOs compared with pregnancies of women with SLE. In contrast, a similar rate of APOs was found when pre-RA pregnancies were compared with GenPop pregnancies.
Our findings of an increased risk of APO in certain pre-ARDs highlights the relevance of taking an obstetric history during the first rheumatology appointment and the need for novel screening strategies for the prediction of APOs. Further research is required to elucidate the immune basis of APOs in preclinical and clinical ARD.
患有自身免疫性风湿病（ARD）的女性与普通人群（GenPop）相比，其不良母婴和胎儿妊娠并发症（包括子痫前期、宫内生长受限和胎儿小于胎龄）的风险增加已得到充分描述。然而，在产后多年被诊断为 ARD 之前，患有“临床前 ARD”（pre-ARD）的女性是否也存在这种不良妊娠结局（APO）的风险尚不清楚。因此，我们对随后被诊断为风湿性疾病的患者的可用 APO 证据进行了系统评价，以确定 pre-ARD 是否存在风险增加。
本研究按照系统评价和荟萃分析的首选报告项目（PRISMA）标准进行报告。使用在线 PubMed 数据库进行系统文献检索。Pre-SLE 和 pre-RA 患者被定义为在随后的几年中根据国际分类标准发展为 SLE 或 RA 的患者。
共筛选出 176 篇文章，最终分析了 27 篇原始文章。Pre-RA 是研究最多的组别，有 15 项研究，共有>1600 次妊娠，Pre-SLE 是妊娠中研究第二多的 Pre-ARD，有 14 项研究，共有>1000 次妊娠。我们发现，与 GenPop 中的孕妇相比，随后发展为 SLE 的患者不良妊娠结局的负担增加，但与 SLE 患者的妊娠相比，不良妊娠结局的数量减少。相比之下，当将 pre-RA 妊娠与 GenPop 妊娠进行比较时，发现其不良妊娠结局的发生率相似。
我们发现某些 Pre-ARD 存在不良妊娠结局风险增加，这强调了在首次风湿病就诊时询问产科病史的相关性，以及需要新的预测不良妊娠结局的筛查策略。需要进一步研究阐明临床前和临床 ARD 中不良妊娠结局的免疫基础。
