Department of Rheumatology and Immunology, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530016, China.
Arch Gynecol Obstet. 2024 Apr;309(4):1135-1149. doi: 10.1007/s00404-023-07259-3. Epub 2023 Nov 3.
To show the impact of Sjögren's syndrome (SS) on maternal and fetal outcomes following pregnancy.
We performed a literature search based on PubMed, Web of science, Wan fang, China National Knowledge Infrastructure and ProQuest databases from 1 January 2007 to 6 November 2022. Grading of Recommendations, Assessment, Development, and Evaluations approach was used to assess the certainty of the evidence. Systematic reviews and meta-analyses were performed using RevMan 5.3 software. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. Trial sequential analyses were performed by TSA 0.9.
Nine studies with 2341 patients and 2472 pregnancies with SS were included in our analysis. This current analysis showed pregnancy hypertension and preeclampsia/eclampsia to be significantly higher in pregnant women with SS compared to pregnant women without SS (OR: 1.65, 95% CI: 1.04-2.63; P = 0.03), (OR: 2.06, 95% CI: 1.16-3.65; P = 0.01) respectively. Cesarean section, thromboembolic disease, premature rupture of membranes, and spontaneous abortion were also significantly higher in the SS women with OR: 2.07, 95% CI: 1.48-2.88; P < 0.0001, OR: 9.45, 95% CI: 1.99-44.87; P = 0.005, OR: 1.36, 95% CI: 1.13-1.64; P = 0.001, OR: 9.30, 95% CI: 4.13-20.93; P < 0.00001, respectively. Significantly higher premature births were observed with infants who were born from SS mothers (OR: 2.19, 95% CI: 1.54-3.12; P < 0.0001). Infants defined as 'small for gestational age/intrauterine growth restriction' and 'weighing < 2500 g' were also significantly higher in patients suffering from SS (OR: 2.26, 95% CI: 1.38-3.70; P = 0.001), (OR: 3.84, 95% CI: 1.39-10.61; P = 0.009) respectively. In addition, live birth significantly favored infants who were born from mothers without SS (OR: 21.53, 95% CI: 8.36-55.44; P < 0.00001). Subgroup analysis by sample size revealed that pregnancy hypertension risk has significantly increased in small cohort (OR: 2.74, 95%CI: 1.45-5.18), and a slight increase was found in population-based studies (OR: 1.14, 95%CI: 0.91-1.43). In both small cohorts and population-based researches, cesarean section was significantly higher in SS (OR: 2.13, 95% CI: 1.29, 3.52; OR: 1.85, 95% CI: 1.29-2.64, respectively). The number of infants with intrauterine growth restriction did not grow in the population-based researches (OR: 2.07, 95%CI: 0.92-4.66) although there has been an increase in small reports (OR: 2.53, 95%CI: 1.16-5.51). Subgroup analysis was conducted on the basis of study location (not Asian vs. Asian countries) indicated that cesarean section was significantly higher in SS in both countries (OR: 1.69, 95% CI: 1.31-2.18; OR: 3.37, 95% CI: 2.39-4.77, respectively).
This meta-analysis has shown SS to have a high impact on maternal and fetal outcomes following pregnancy.
展示干燥综合征 (SS) 对妊娠后母婴结局的影响。
我们基于 PubMed、Web of Science、万方、中国知网和 ProQuest 数据库，检索了 2007 年 1 月 1 日至 2022 年 11 月 6 日的文献。采用 Grading of Recommendations, Assessment, Development, and Evaluations 方法评估证据的确定性。使用 RevMan 5.3 软件进行系统评价和荟萃分析。采用 DerSimonian 和 Laird 的随机效应、通用逆方差方法计算合并优势比 (OR) 和 95%置信区间 (CI)。通过 TSA 0.9 进行试验序贯分析。
纳入了 9 项研究，共纳入 2341 例患者和 2472 例妊娠 SS 的患者。本分析表明，与无 SS 的孕妇相比，SS 孕妇的妊娠高血压和子痫前期/子痫（OR：1.65，95%CI：1.04-2.63；P=0.03）、剖宫产（OR：2.06，95%CI：1.16-3.65；P=0.01）、血栓栓塞性疾病（OR：9.45，95%CI：1.99-44.87；P=0.005）、胎膜早破（OR：1.36，95%CI：1.13-1.64；P=0.001）和自然流产（OR：9.30，95%CI：4.13-20.93；P<0.00001）的发生率显著升高。早产的发生率也显著升高，与 SS 母亲分娩的婴儿相比（OR：2.19，95%CI：1.54-3.12；P<0.0001）。患有 SS 的患者中，“小于胎龄儿/宫内生长受限”和“体重<2500g”的婴儿比例也显著升高（OR：2.26，95%CI：1.38-3.70；P=0.001）和（OR：3.84，95%CI：1.39-10.61；P=0.009）。此外，活产明显有利于无 SS 母亲分娩的婴儿（OR：21.53，95%CI：8.36-55.44；P<0.00001）。按样本量进行的亚组分析表明，小样本队列中妊娠高血压的风险显著增加（OR：2.74，95%CI：1.45-5.18），而在基于人群的研究中则略有增加（OR：1.14，95%CI：0.91-1.43）。在小样本队列和基于人群的研究中，SS 患者的剖宫产率均显著升高（OR：2.13，95%CI：1.29-3.52；OR：1.85，95%CI：1.29-2.64）。虽然小样本报告中（OR：2.53，95%CI：1.16-5.51）有所增加，但基于人群的研究中，宫内生长受限的婴儿数量并未增加（OR：2.07，95%CI：0.92-4.66）。基于研究地点（非亚洲与亚洲国家）的亚组分析表明，SS 患者的剖宫产率在两国均显著升高（OR：1.69，95%CI：1.31-2.18；OR：3.37，95%CI：2.39-4.77）。
本荟萃分析表明，SS 对妊娠后母婴结局有较大影响。
