Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX (Ms Keum, Drs Jacobe and Chong).
Division of Rheumatology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX (Dr Bermas).
Am J Obstet Gynecol MFM. 2024 Jan;6(1):101226. doi: 10.1016/j.ajogmf.2023.101226. Epub 2023 Nov 14.
Increased rates of adverse pregnancy outcomes have been reported in association with rheumatologic diseases such as systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis. However, little is known about pregnancy outcomes in patients with autoimmune skin diseases.
This study aimed to determine the frequency of adverse pregnancy outcomes in patients with autoimmune skin diseases. We hypothesized that similar to rheumatic diseases, the rate of adverse pregnancy outcomes in patients with autoimmune skin diseases would be higher than the general population.
This is a case control study using the TriNetX US Collaborative Network, which is a database of electronic medical records of >95 million patients seen at 57 healthcare organizations in the United States. All pregnant women between the ages of 15 and 44 years who were seen at a healthcare organization between January 1, 2016 and December 31, 2021 were included. Participants with autoimmune skin disease were matched to healthy controls and controls with systemic rheumatologic conditions (systemic lupus erythematosus or rheumatoid arthritis). For both the autoimmune skin disease and healthy control groups, those with systemic rheumatologic condition or hidradenitis suppurativa were excluded. The primary outcomes were adverse pregnancy outcomes defined as spontaneous abortion, gestational hypertension, preeclampsia or eclampsia, gestational diabetes mellitus, intrauterine growth restriction, preterm premature rupture of membranes, preterm birth, and stillbirth. Patients with autoimmune skin diseases and controls were 1:1 propensity score-matched by age, race, ethnicity, comorbidities, obesity, and substance use. For each outcome, odds ratio with a 95% confidence interval was calculated.
A total of 2788 patients with autoimmune skin diseases were matched to 2788 healthy controls. Patients with autoimmune skin diseases were at a higher risk of spontaneous abortions than controls (odds ratio, 1.54; 95% confidence interval, 1.36-1.75; P<.001). Compared with patients with systemic lupus erythematosus, patients with autoimmune skin diseases were at lower risk of having infants with intrauterine growth restriction (odds ratio, 0.59; 95% confidence interval, 0.4-0.87; P=.01), preterm birth (odds ratio, 0.68; 95% confidence interval, 0.47-0.98; P=.04), and stillbirth (odds ratio, 0.50; 95% confidence interval, 0.25-0.97; P=.04). The differences in adverse pregnancy outcomes between patients with autoimmune skin diseases and those with rheumatoid arthritis were not statistically significant.
Patients with autoimmune skin diseases are at a higher risk of spontaneous abortions than patients without autoimmune skin diseases. When analyzed by each autoimmune skin disease, patients with cutaneous lupus erythematosus or vitiligo remained at increased risk of spontaneous abortions compared with patients without autoimmune skin diseases. Patients with autoimmune skin diseases have similar risks of adverse pregnancy outcomes as patients with rheumatoid arthritis, but lower risks than patients with systemic lupus erythematosus.
已有研究报道，红斑狼疮、类风湿关节炎、皮肌炎等风湿性疾病与不良妊娠结局的发生率增加相关。然而，人们对自身免疫性皮肤病患者的妊娠结局知之甚少。
本研究旨在确定自身免疫性皮肤病患者不良妊娠结局的发生频率。我们假设，与风湿性疾病类似，自身免疫性皮肤病患者的不良妊娠结局发生率高于普通人群。
这是一项使用 TriNetX US 合作网络的病例对照研究，该网络是一个包含美国 57 家医疗机构 9500 多万患者电子病历的数据库。纳入 2016 年 1 月 1 日至 2021 年 12 月 31 日期间在医疗机构就诊的年龄在 15 至 44 岁之间的所有孕妇。将自身免疫性皮肤病患者与健康对照组和系统性风湿性疾病（系统性红斑狼疮或类风湿关节炎）对照组相匹配。对于自身免疫性皮肤病组和健康对照组，均排除患有系统性风湿性疾病或化脓性汗腺炎的患者。主要结局为定义为自然流产、妊娠期高血压、先兆子痫或子痫、妊娠期糖尿病、胎儿宫内生长受限、胎膜早破早产、早产和死产的不良妊娠结局。通过年龄、种族、民族、合并症、肥胖和药物使用对自身免疫性皮肤病患者和对照组进行 1:1 倾向评分匹配。对于每个结局，计算比值比及其 95%置信区间。
共 2788 例自身免疫性皮肤病患者与 2788 例健康对照组相匹配。与对照组相比，自身免疫性皮肤病患者自然流产的风险更高（比值比，1.54；95%置信区间，1.36-1.75；P<.001）。与系统性红斑狼疮患者相比，自身免疫性皮肤病患者的胎儿宫内生长受限（比值比，0.59；95%置信区间，0.4-0.87；P=.01）、早产（比值比，0.68；95%置信区间，0.47-0.98；P=.04）和死产（比值比，0.50；95%置信区间，0.25-0.97；P=.04）的风险较低。自身免疫性皮肤病患者与类风湿关节炎患者之间的不良妊娠结局差异无统计学意义。
与无自身免疫性皮肤病的患者相比，自身免疫性皮肤病患者自然流产的风险更高。当按每种自身免疫性皮肤病进行分析时，与无自身免疫性皮肤病的患者相比，红斑狼疮或白癜风患者自然流产的风险仍然较高。自身免疫性皮肤病患者的不良妊娠结局风险与类风湿关节炎患者相似，但低于系统性红斑狼疮患者。
