Huang Wei, Wu Teng, Jin Tianyu, Zhang Yuan, Wang Jing, Qi Jiaping, Li Yixuan, Jiang Huan, Zhang Ju, Jiang Zhaoyu, Chen Lin, Ying Zhenhua
Zhejiang Provincial People's Hospital, Qingdao University, No.158 Shangtang Road, Hangzhou, 310014, China.
Rheumatism and Immunity Research Institute, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No.158 Shangtang Road, Hangzhou, 310014, China.
Clin Rheumatol. 2023 Mar;42(3):855-870. doi: 10.1007/s10067-022-06436-0. Epub 2022 Nov 11.
Rheumatoid arthritis (RA) is a common chronic systemic autoimmune disease affecting women of childbearing age. We aimed to conduct a meta-analysis of published observational studies to systematically evaluate the association between RA and adverse pregnancy outcomes.
Medline (PubMed), EMBASE, and Web of Science were searched for keywords from the date of inception to December 28, 2021, to identify relevant studies reporting adverse maternal and/or fetal outcomes in RA pregnancies. Data from individual studies were pooled using random-effects models and presented as odds ratios (ORs) with 95% confidence intervals (CIs).
Eighteen studies with a total number of over 50 million participants were eligible for inclusion. This current analysis showed that in pregnant women with RA, there was a significantly increased risk of adverse maternal outcomes, including caesarean section (OR, 1.39; 95% CI 1.24-1.55), pre-eclampsia (OR, 1.48; 95% CI 1.19-1.83), gestational hypertension (OR, 1.34; 95% CI 1.07-1.68) and spontaneous abortion (OR, 1.16; 95% CI 1.04-1.29). Similarly, maternal RA during pregnancy was also associated with a significantly increased risk of adverse fetal outcomes, including preterm birth (OR, 1.58; 95% CI 1.44-1.74), small for gestational age (OR, 1.49; 95% CI 1.22-1.82), low birth weight (OR, 1.45; 95% CI 1.30-1.63), congenital anomalies (OR, 1.36; 95% CI 1.01-1.83) and stillborn (OR, 1.38; 95% CI 1.09-1.74).
Maternal RA is significantly associated with an increased risk of adverse maternal and fetal outcomes. Close monitoring of the clinical status of RA patients before and during pregnancy is essential in clinical practice. Key Points • Pregnant women with rheumatoid arthritis (RA) are at significantly increased risk for adverse maternal and fetal outcomes. • The increased risk of adverse pregnancy outcomes in women with RA may be closely related to medication use and disease activity. • Close monitoring of the clinical status of RA patients before and during pregnancy is essential in clinical practice.
类风湿关节炎（RA）是一种常见的慢性全身性自身免疫性疾病，影响育龄女性。我们旨在对已发表的观察性研究进行荟萃分析，以系统评估RA与不良妊娠结局之间的关联。
检索Medline（PubMed）、EMBASE和Web of Science，从创刊日期至2021年12月28日，以识别报告RA妊娠中不良母体和/或胎儿结局的相关研究。使用随机效应模型汇总个体研究的数据，并以比值比（OR）和95%置信区间（CI）呈现。
18项研究，总参与者超过5000万，符合纳入标准。当前分析表明，患有RA的孕妇出现不良母体结局的风险显著增加，包括剖宫产（OR，1.39；95%CI 1.24 - 1.55）、子痫前期（OR，1.48；95%CI 1.19 - 1.83）、妊娠期高血压（OR，1.34；95%CI 1.07 - 1.68）和自然流产（OR，1.16；95%CI 1.04 - 1.29）。同样，孕期母体RA也与不良胎儿结局的风险显著增加相关，包括早产（OR，1.58；95%CI 1.44 - 1.74）、小于胎龄儿（OR，1.49；95%CI 1.22 - 1.82）、低出生体重（OR，1.45；95%CI 1.30 - 1.63）、先天性异常（OR，1.36；95%CI 1.01 - 1.83）和死产（OR，1.38；95%CI 1.09 - 1.74）。
母体RA与不良母体和胎儿结局的风险增加显著相关。在临床实践中，密切监测RA患者妊娠前和妊娠期间的临床状况至关重要。要点 • 患有类风湿关节炎（RA）的孕妇出现不良母体和胎儿结局的风险显著增加。 • RA女性不良妊娠结局风险增加可能与药物使用和疾病活动密切相关。 • 在临床实践中，密切监测RA患者妊娠前和妊娠期间的临床状况至关重要。
