Tafreshian Shadan, Salari Masoumeh, Mirfeizi Zahra, Akhlaghi Saeed, Samadi Sara, Sahebari Maryam
Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
J Obstet Gynaecol India. 2025 Apr;75(Suppl 1):287-294. doi: 10.1007/s13224-024-01974-w. Epub 2024 Jun 12.
We aim to investigate the maternal and fetal complications among women with rheumatic diseases (RDs) and evaluate the risk factors for adverse pregnancy outcomes.
In this cohort study, 241 women (comprising 401 pregnancies) who were diagnosed with RDs and sought treatment between 2016 and 2021 were evaluated and followed up for a duration of two years. Clinical backgrounds, pregnancy history, medication usage, immunological characteristics, and pregnancy outcomes were analyzed. Risk assessment for adverse outcomes in RDs was performed using binary logistic regression.
The study revealed a 38.2% miscarriage rate and 56.9% live birth rate among 401 pregnancies. Maternal adverse events included gestational hypertension (4.7%), gestational diabetes mellitus (2.7%), and (pre)eclampsia (1.7%). Fetal adverse outcomes consisted of miscarriages in 153 (38.2%), low birth weight in 45 (11.2%), preterm labor in 20 (5%), and fetal heart block in eight (2%). Risk factors associated with adverse fetal outcomes were systemic lupus erythematosus (SLE) (OR 8.24, 95% CI 1.65-41.15), vasculitis (OR 8.06, 95% CI 2.7-24.02), SLE/Sjögren's syndrome (SS) overlap (OR 4.05, 95% CI 1.8-9.11), and history of hypothyroidism (OR 2.81, 95% CI 1.52-5.2).
RDs exerted a negative impact on pregnancy outcomes, resulting in complications for both the mother and the fetus. Our study emphasizes the significance of effectively managing RDs during pregnancy, with particular emphasis on SLE, vasculitis, and the overlap of SS with SLE. To improve pregnancy outcomes, a multidisciplinary approach, early identification of high-risk patients, and the implementation of individualized treatment plans are recommended.
我们旨在调查患有风湿性疾病（RDs）的女性的母婴并发症，并评估不良妊娠结局的风险因素。
在这项队列研究中，对2016年至2021年间被诊断患有RDs并寻求治疗的241名女性（包括401次妊娠）进行了评估，并随访了两年。分析了临床背景、妊娠史、药物使用情况、免疫特征和妊娠结局。使用二元逻辑回归对RDs不良结局进行风险评估。
该研究显示，在401次妊娠中，流产率为38.2%，活产率为56.9%。母亲的不良事件包括妊娠期高血压（4.7%）、妊娠期糖尿病（2.7%）和（先兆）子痫（1.7%）。胎儿不良结局包括153例流产（38.2%）、45例低出生体重（11.2%）、20例早产（5%）和8例胎儿心脏传导阻滞（2%）。与胎儿不良结局相关的风险因素包括系统性红斑狼疮（SLE）（比值比8.24，95%置信区间1.65 - 41.15）、血管炎（比值比8.06，95%置信区间2.7 - 24.02）、SLE/干燥综合征（SS）重叠综合征（比值比4.05，95%置信区间1.8 - 9.11）以及甲状腺功能减退病史（比值比2.81，95%置信区间1.52 - 5.2）。
RDs对妊娠结局产生负面影响，导致母亲和胎儿出现并发症。我们的研究强调了孕期有效管理RDs的重要性，尤其要关注SLE、血管炎以及SS与SLE的重叠综合征。为改善妊娠结局，建议采用多学科方法，早期识别高危患者并实施个体化治疗方案。
