系统性红斑狼疮女性生育治疗的安全性：基于人群的前瞻性研究数据

Safety of Fertility Treatments in Women With Systemic Lupus Erythematosus: Data From a Prospective Population-Based Study.

作者信息

Dernoncourt Amandine, Guettrot-Imbert Gaëlle, Sentilhes Loïc, Besse Marie Charlotte, Molto Anna, Queyrel-Moranne Viviane, Besnerais Maelle Le, Lazaro Estibaliz, Tieulié Nathalie, Richez Christophe, Hachulla Eric, Sarrot-Reynauld Françoise, Leroux Gaëlle, Orquevaux Pauline, London Jonathan, Sailler Laurent, Souchaud-Debouverie Odile, Smets Perrine, Godeau Bertrand, Pannier Emmanuelle, Murarasu Anne, Berezne Alice, Goulenok Tiphaine, Morel Nathalie, Mouthon Luc, Duhaut Pierre, Guern Véronique Le, Costedoat-Chalumeau Nathalie

机构信息

Service de Médecine Interne et RECIF, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France.

Service de Médecine Interne, Centre de référence Des Maladies Auto-Immunes et Auto-Inflammatoires systémiques Rares d'Ile-de-France, de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP)-Université Paris Cité, Paris, France.

出版信息

BJOG. 2025 Apr;132(5):614-624. doi: 10.1111/1471-0528.18050. Epub 2024 Dec 19.

DOI:10.1111/1471-0528.18050

PMID:39702994

Abstract

OBJECTIVE

To assess safety of fertility treatments in women with systemic lupus erythematosus (SLE).

DESIGN

Data from the multicentre French observational GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares) study (2014-ongoing).

SETTING

Seventy-six centres in France.

POPULATION

All pregnancies in women with SLE enrolled in the GR2 study, conceived before 1 August 2022, with available end-of-pregnancy data and known conception type, were included; that is, 577 spontaneous and 53 assisted pregnancies.

METHODS

A comparative analysis of spontaneous and assisted pregnancies was conducted. Logistic regression was used to determine if fertility treatments were independently associated with live birth prognosis, adjusting for confounders (e.g., maternal age). Kaplan-Meier analysis compared cumulative incidences of disease flares and adverse pregnancy outcomes (APOs), with confounding factors adjusted using a Cox regression model.

MAIN OUTCOME MEASURES

Live birth, disease flares, and APOs.

RESULTS

The mean age was older (35.8 vs. 32.3 years, p < 1 × 10), and twins were more frequent in assisted pregnancies (5/50, 10.0% vs. 20/554, 3.6%; p = 0.047). Lupus disease was clinically inactive at baseline in 51 (96.2%) assisted pregnancies (vs. n = 511, 89.6%; p = 0.15), with 35 of 45 (77.8%) having no chronic damage (vs. 448/513, 87.3%; p = 0.07). The live birth rate was similar between assisted and spontaneous pregnancies (n = 46, 86.8% vs. n = 505, 87.5%; p = 0.83), with no statistical difference in the incidence of lupus flares and APOs. These results remained consistent after adjusting for confounding factors.

CONCLUSIONS

Fertility treatments in women with mostly well-controlled SLE did not appear to increase risks of maternal and neonatal complications, supporting current recommendations. Trial Registration ClinicalTrials.gov identifier: NCT02450396.

摘要

目的

评估系统性红斑狼疮（SLE）女性患者生育治疗的安全性。

设计

来自多中心法国观察性GR2（妊娠与罕见病研究组）研究（2014年至今）的数据。

地点

法国的76个中心。

研究对象

纳入GR2研究中所有SLE女性患者的妊娠情况，这些妊娠发生在2022年8月1日之前，有妊娠末期数据且受孕类型已知；即577例自然妊娠和53例辅助妊娠。

方法

对自然妊娠和辅助妊娠进行比较分析。采用逻辑回归确定生育治疗是否与活产预后独立相关，并对混杂因素（如产妇年龄）进行校正。采用Kaplan-Meier分析比较疾病复发和不良妊娠结局（APO）的累积发生率，并使用Cox回归模型对混杂因素进行校正。

主要观察指标

活产、疾病复发和APO。

结果

辅助妊娠组的平均年龄较大（35.8岁对32.3岁，p<1×10），辅助妊娠中双胎更常见（5/50，10.0%对20/554，3.6%；p=0.047）。51例（96.2%）辅助妊娠在基线时狼疮病情临床缓解（对n=511例，89.6%；p=0.15），45例中有35例（77.8%）无慢性损害（对448/513例，87.3%；p=0.07）。辅助妊娠和自然妊娠的活产率相似（n=46例，86.8%对n=505例，87.5%；p=0.83），狼疮复发和APO的发生率无统计学差异。校正混杂因素后，这些结果仍然一致。