孕期心血管事件：对自身免疫性和风湿性疾病患者不良妊娠结局的影响
Cardiovascular Events During Pregnancy: Implications for Adverse Pregnancy Outcomes in Individuals With Autoimmune and Rheumatic Diseases.
作者信息
Dhital Rashmi, Baer Rebecca J, Bandoli Gretchen, Chambers Christina
机构信息
R. Dhital, MD, Department of Medicine, Division of Rheumatology, Autoimmunity and Inflammation, School of Medicine, University of California San Diego, La Jolla, California, now with Department of Medicine, Division of Rheumatology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee;
R.J. Baer, MPH, Department of Pediatrics, Division of Environmental Science and Health, School of Medicine, University of California San Diego, La Jolla, and the California Preterm Birth Initiative, University of California San Francisco, San Francisco, California.
出版信息
J Rheumatol. 2025 Jan 1;52(1):93-99. doi: 10.3899/jrheum.2024-0306.
OBJECTIVE
This study examined maternal cardiovascular (CV) events relative to adverse pregnancy outcomes (APOs) among individuals with autoimmune rheumatic diseases (ARDs), primary antiphospholipid syndrome (APS), and those with neither.
METHODS
Using a California population-based birth cohort (2005-2020), we identified those with CV events (CVEs), ARDs, and APS through International Classification of Diseases, 9th and 10th revisions, Clinical Modification codes in maternal discharge records. Selected APOs identified from birth certificates were preterm birth (PTB; < 37 weeks' gestation), small-for-gestational-age infants (SGA; birth weight < 10th percentile for age and sex), and a composite of either outcome. Adjusted risk ratios (aRRs) for adverse outcomes and their 95% CIs were calculated.
RESULTS
CVEs occurred more frequently in individuals with ARDs (265 of 19,340 [1.4%]) and primary APS (428 of 7758 [5.5%]) than those without (17,130 of 7,004,334 [0.3%]). The presence vs absence of CVEs was associated with a greater incidence of adverse outcomes in ARD (53.2% vs 26.6%), APS (30.6% vs 20.7%), and non-ARD/APS pregnancies (28.2% vs 15.2%). CVEs were associated with increased risks of SGA in all groups (aRRs 1.2-1.5) and PTB in ARD (aRR 1.6, 95% CI 1.3-2.0) and non-ARD/APS (aRR 1.7, 95% CI 1.7-1.8) pregnancies.
CONCLUSION
CVEs were associated with modestly increased risks (20-70%) for PTB, SGA, or both across the groups. Notably, > 50% of ARD pregnancies with CVEs experienced APOs. Given that ARD and APS pregnancies have higher (although still low) rates of CVEs and have higher baseline risks of APOs than the general population, the additional burden conferred by CVEs is clinically important.
目的
本研究调查了自身免疫性风湿疾病（ARD）、原发性抗磷脂综合征（APS）患者以及无上述疾病的个体中，孕产妇心血管（CV）事件与不良妊娠结局（APO）之间的关系。
方法
利用加利福尼亚州基于人群的出生队列（2005 - 2020年），我们通过孕产妇出院记录中的国际疾病分类第9版和第10版临床修订编码，识别出患有CV事件（CVE）、ARD和APS的个体。从出生证明中确定的选定APO包括早产（PTB；妊娠<37周）、小于胎龄儿（SGA；出生体重低于年龄和性别的第10百分位数）以及这两种结局的复合情况。计算不良结局的调整风险比（aRR）及其95%置信区间（CI）。
结果
患有ARD（19340例中的265例[1.4%]）和原发性APS（7758例中的428例[5.5%]）的个体中CVE的发生频率高于无上述疾病的个体（7004334例中的17130例[0.3%]）。患有与未患有CVE与ARD（53.2%对26.6%）、APS（30.6%对20.7%）以及非ARD/APS妊娠（28.2%对15.2%）中不良结局发生率较高相关。CVE与所有组中SGA风险增加（aRR为1.2 - 1.5）以及ARD（aRR为1.6，95%CI为1.3 - 2.0）和非ARD/APS（aRR为1.7，95%CI为1.7 - 1.8）妊娠中PTB风险增加相关。
结论
CVE与各组中PTB和SGA或两者风险适度增加（20% - 70%）相关。值得注意的是，患有CVE的ARD妊娠中有超过50%经历了APO。鉴于ARD和APS妊娠的CVE发生率较高（尽管仍然较低）且APO的基线风险高于一般人群，CVE带来的额外负担在临床上具有重要意义。
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