Harding Ceshae C, Eudy Amanda M, Sims Cathrine A, Edens Cuoghi, Birru Talabi Mehret, Ramsey-Goldman Rosalind, Neil Laura, Clowse Megan E B
Duke University School of Medicine, Durham, North Carolina.
University of Chicago Medicine, Chicago, Illinois.
Arthritis Care Res (Hoboken). 2024 Sep 8. doi: 10.1002/acr.25430.
Among individuals with systemic lupus erythematosus (SLE) who became pregnant, we explored the impact of medical readiness for pregnancy and personal readiness for pregnancy on the following aspects of maternal health: (1) provider-reported disease activity, (2) patient-perceived disease activity, (3) mood symptoms, (4) pregnancy-related health behaviors, and (5) pregnancy outcomes.
All study participants were enrolled in a prospective registry, met Systemic Lupus Collaborating Clinics (SLICC) criteria for SLE, and had at least one pregnancy. Patient-reported outcomes were collected at the first rheumatology visit during pregnancy. "Medically ready" for pregnancy was defined as (1) <1 g of proteinuria, (2) no rheumatic teratogens at conception, and (3) continuing pregnancy-compatible SLE medications after conception. "Personally ready" was defined as planned pregnancy based on a London Measure of Unplanned Pregnancy score ≥10. Multivariable logistic regression models estimated the association of pregnancy readiness with each outcome of interest.
Among the 111 individuals enrolled, lack of medical readiness for pregnancy was associated with significantly higher rates of active disease and worse pregnancy outcomes; however, these patients did not perceive themselves as having higher disease activity. Lack of personal readiness for pregnancy was associated with significantly higher patient-perceived disease activity. Although medical readiness did not impact depressive symptoms substantially, lack of personal readiness for pregnancy was associated with much higher maternal depressive symptoms.
To improve pregnancy outcomes among individuals with SLE, greater focus is needed on improving medical optimization before conception. For maternal mental health and quality of life, greater focus is needed on decreasing the incidence of unplanned pregnancy.
在已怀孕的系统性红斑狼疮（SLE）患者中，我们探讨了妊娠的医学准备情况和个人准备情况对孕产妇健康以下方面的影响：（1）医疗服务提供者报告的疾病活动度；（2）患者自我感知的疾病活动度；（3）情绪症状；（4）与妊娠相关的健康行为；（5）妊娠结局。
所有研究参与者均纳入前瞻性登记系统，符合系统性红斑狼疮协作诊所（SLICC）的SLE诊断标准，且至少有过一次妊娠。在孕期首次风湿科就诊时收集患者报告的结局。妊娠“医学准备就绪”定义为：（1）蛋白尿<1g；（2）受孕时无风湿性致畸剂；（3）受孕后继续使用与妊娠兼容的SLE药物。“个人准备就绪”定义为基于伦敦意外妊娠量表评分≥10的计划妊娠。多变量逻辑回归模型估计妊娠准备情况与各感兴趣结局之间的关联。
在纳入的111名个体中，妊娠医学准备不足与疾病活动率显著升高及妊娠结局较差相关；然而，这些患者并未自我感觉疾病活动度更高。妊娠个人准备不足与患者自我感知的疾病活动度显著升高相关。虽然医学准备情况对抑郁症状影响不大，但妊娠个人准备不足与孕产妇抑郁症状明显增多相关。
为改善SLE患者的妊娠结局，需要更关注受孕前改善医学优化情况。为了孕产妇的心理健康和生活质量，需要更关注降低意外妊娠的发生率。
