Zhang Xueyang, Liu Lingshan, Lin Shudian, Duan Xinwang, Luo Hui, Wang Yongfu, Wu Zhenbiao, Huang Can, Long Yin, Cui Yixin, Shi Xiaohua, Song Yijun, Liu Juntao, Zeng Xiaofeng, Zhao Jiuliang, Li Mengtao, Tian Xinping
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Rheumatology and Immunology, Hainan General Hospital, Haikou, China.
Arthritis Res Ther. 2025 Feb 11;27(1):31. doi: 10.1186/s13075-025-03497-9.
Systemic lupus erythematosus (SLE) is frequently associated with a lower rate of live birth and a higher incidence of adverse pregnancy outcomes (APOs), and pregnancy can also increase the risk of SLE flares. Comprehensive preconception assessment is critical for improved pregnancy outcomes in patients with SLE. Unfortunately, no global consensus on the conditions that patients with SLE should fulfill prior to pregnancy has yet been formed.
This study aimed to investigate the conditions that patients with SLE should fulfill before pregnancy to optimize outcomes.
This was a retrospective study utilizing data from a multicenter Chinese SLE cohort. Information on demographics, obstetric history, SLE activity, clinical manifestations, autoantibody profiles, laboratory parameters, therapeutics, and pregnancy outcomes was collected. Logistic regression was used to explore the optimal conditions.
The study comprised 347 singleton pregnancies from 332 patients with SLE in total, with a mean maternal age at conception of 30.3 (SD 4.0) years. The analysis revealed that patients who were stable for at least 6 months, had no active vital organ involvement, were on nonfluorinated corticosteroids no more than the dose equivalent to prednisone 7.5 mg per day, and were on hydroxychloroquine displayed a significantly higher incidence of live birth (86.1% vs. 73.7%, p = 0.004) and a markedly decreased risk of APOs (29.4% vs. 52.1%, p < 0.001). Additionally, flares occurred less frequently during pregnancy (14.7% vs. 27.3%, p = 0.009), particularly for severe flares (5.8% vs. 14.8%, p = 0.011).
This study delineated the conditions that patients with SLE should fulfill before pregnancy, which provides better instructions for clinical practice.
系统性红斑狼疮（SLE）常与较低的活产率及较高的不良妊娠结局（APO）发生率相关，且妊娠也会增加SLE病情复发的风险。全面的孕前评估对于改善SLE患者的妊娠结局至关重要。遗憾的是，目前尚未就SLE患者妊娠前应满足的条件达成全球共识。
本研究旨在探讨SLE患者妊娠前应满足的条件，以优化妊娠结局。
这是一项回顾性研究，利用了来自中国多中心SLE队列的数据。收集了人口统计学、产科病史、SLE活动度、临床表现、自身抗体谱、实验室参数、治疗方法及妊娠结局等信息。采用逻辑回归分析来探索最佳条件。
该研究共纳入了332例SLE患者的347次单胎妊娠，妊娠时孕妇的平均年龄为30.3（标准差4.0）岁。分析显示，病情稳定至少6个月、无重要脏器活动性受累、使用的非氟化皮质类固醇剂量不超过相当于每天7.5毫克泼尼松的剂量且正在服用羟氯喹的患者，其活产率显著更高（86.1%对73.7%，p = 0.004），APO风险明显降低（29.4%对52.1%，p < 0.001）。此外，妊娠期间病情复发的频率较低（14.7%对27.3%，p = 0.009），尤其是严重复发（5.8%对14.8%，p = 0.011）。
本研究明确了SLE患者妊娠前应满足的条件，为临床实践提供了更好的指导。
