Department of Medicine, Division of Rheumatology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Medicine, Division of Rheumatology, Autoimmunity and Inflammation, School of Medicine, University of California San Diego, La Jolla, CA, USA.
Rheumatology (Oxford). 2024 Nov 1;63(11):3006-3014. doi: 10.1093/rheumatology/keae454.
Up to a quarter of pregnant individuals with SLE have small for gestational age (SGA) infants. We aimed to characterize placental pathology associated with SGA infants in SLE.
We retrospectively analysed SLE deliveries with placental analysis at UCSD from November 2018 to October 2023, comparing SLE pregnancies resulting in SGA to those that did not, and additionally, to matched pregnancies with SGA but without SLE.
Placental analysis was available only for 28/70 (40%) SLE deliveries, which had high rates of adverse outcomes (75%). All exhibited at least one histopathologic abnormality. Key findings distinguishing 12 SLE placentas resulting in SGA infants (vs.16 without) included small placental disc for gestational age (100% vs 56%, P = 0.01), placental disc infarct (50% vs 6%, P = 0.02) and increased perivillous fibrin deposition (PVFD, 58% vs 0%, P = 0.001). All seven SLE placentas with increased PVFD resulted in SGA infants. Compared with matched non-SLE pregnancies with SGA (n = 36), the only distinguishing placental lesion was a higher prevalence of increased PVFD in SLE-associated SGA (58% vs 22%, P = 0.03).
The higher prevalence of increased PVFD in placentas of SLE-associated SGA may indicate a specific mechanism of placental injury leading to SGA in this context. Thus, its presence, particularly in context of SGA, should prompt providers to screen for an underlying autoimmune disease, including SLE. Systematic placental examination in context of SLE and associated autoimmune diseases could help evaluate responses to existing therapies, comparative studies of novel therapies and correlation to adverse outcomes.
多达四分之一患有 SLE 的孕妇会出现胎儿生长受限（SGA）。本研究旨在探讨 SLE 患者中与 SGA 相关的胎盘病理特征。
我们回顾性分析了 2018 年 11 月至 2023 年 10 月在 UCSD 进行的胎盘分析的 SLE 分娩病例，比较了 SLE 妊娠中导致 SGA 的病例与未导致 SGA 的病例，并进一步与 SGA 但无 SLE 的匹配妊娠进行了比较。
仅对 70 例 SLE 分娩中的 28 例（40%）进行了胎盘分析，这些分娩的不良结局发生率很高（75%）。所有病例均至少存在一种组织病理学异常。区分 12 例 SLE 胎盘导致 SGA 婴儿（vs.16 例无）的关键发现包括胎盘直径小于胎龄（100% vs 56%，P=0.01）、胎盘梗死（50% vs 6%，P=0.02）和绒毛外纤维蛋白沉积增加（PVFD，58% vs 0%，P=0.001）。所有 7 例 PVFD 增加的 SLE 胎盘均导致 SGA 婴儿。与 SGA 的匹配非 SLE 妊娠（n=36）相比，唯一的区别是 SLE 相关 SGA 中增加的 PVFD 更为常见（58% vs 22%，P=0.03）。
SLE 相关 SGA 胎盘中增加的 PVFD 更常见，这可能表明在这种情况下存在导致 SGA 的特定胎盘损伤机制。因此，特别是在 SGA 的情况下，其存在应促使提供者筛查潜在的自身免疫性疾病，包括 SLE。在 SLE 和相关自身免疫性疾病的背景下进行系统性胎盘检查，可以帮助评估现有治疗的反应、新型治疗的比较研究以及与不良结局的相关性。
