Mohan Prajwal, Chengappa Kavadichanda G, Sharma Jyotsna, Gupta Avantika, Adhisivam Bethou, Negi Vir Singh, Keepanasseril Anish
Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.
Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.
Int J Rheum Dis. 2025 Jun;28(6):e70328. doi: 10.1111/1756-185X.70328.
To assess the strength of the association of systemic lupus erythematosus (SLE) with feto-maternal outcomes compared to those without SLE (healthy controls) beyond 20 weeks of gestation, and to determine the factors associated with a flare during pregnancy and postpartum among those with SLE.
This matched-observational study was conducted between 2011 and 2020 in a tertiary referral center in southeastern India, comparing feto-maternal outcomes such as preterm birth, hypertensive disorders of pregnancy (HDP), small for gestational age (SGA), among pregnancies that crossed 20 weeks, with and without SLE (ratio of 1:1). Rates of lupus flare among cases were studied. Conditional logistic regression assessed the association between SLE and fetal-maternal outcomes matched for age, whereas factors associated with lupus flare were assessed by multivariate logistic regression, expressed as adjusted odds ratios (OR) with a 95% confidence interval (95% CI).
During the study period, there were 144 cases of SLE, and 27 (18.8%) were diagnosed for the first time during pregnancy. Those with SLE had higher odds for HDP (OR: 5.10, 95% CI: 2.39-10.88), SGA (OR: 2.21, 95% CI: 1.24-3.91), preterm birth (< 37 weeks) (OR: 2.61, 95% CI: 1.36-5.02), and perinatal loss (OR: 13.92, 95% CI: 1.79-108.45), than those without SLE (n = 144). The most common neonatal lupus presentation was complete heart block. Among those with SLE, HDP (OR: 9.99, 95% CI: 2.42-41.26) and lupus nephritis (OR: 4.62, 95% CI: 1.21-17.63) increased the risk of perinatal loss. Flares occurred in 27 (18.8%) cases, with six having multiple flares, and hydroxychloroquine was associated with its reduction (OR: 0.15, 95% CI: 0.03-0.71).
Pregnant women with SLE had a higher risk of adverse feto-maternal outcomes than those without SLE, beyond 20 weeks of gestation. Lupus nephritis and HDP increase the risk of perinatal loss, whereas hydroxychloroquine usage reduces lupus flare.
评估妊娠20周后系统性红斑狼疮（SLE）与胎儿-母亲结局之间关联的强度，并与无SLE者（健康对照）进行比较，同时确定SLE患者在孕期和产后发生病情复发的相关因素。
这项匹配观察性研究于2011年至2020年在印度东南部的一家三级转诊中心进行，比较妊娠超过20周的有SLE和无SLE（比例为1:1）的孕妇的胎儿-母亲结局，如早产、妊娠高血压疾病（HDP）、小于胎龄儿（SGA）。研究了病例组中狼疮病情复发的发生率。条件逻辑回归分析评估了SLE与年龄匹配的胎儿-母亲结局之间的关联，而与狼疮病情复发相关的因素则通过多变量逻辑回归进行评估，以调整优势比（OR）和95%置信区间（95%CI）表示。
在研究期间，有144例SLE病例，其中27例（18.8%）在孕期首次诊断。与无SLE者（n = 144）相比，SLE患者发生HDP（OR：5.10，95%CI：2.39 - 10.88）、SGA（OR：2.21，95%CI：1.24 - 3.91）、早产（< 37周）（OR：2.61，95%CI：1.36 - 5.02）和围产期死亡（OR：13.92，95%CI：1.79 - 108.45）的几率更高。最常见的新生儿狼疮表现是完全性心脏传导阻滞。在SLE患者中，HDP（OR：9.99，95%CI：2.42 - 41.26）和狼疮性肾炎（OR：4.62，95%CI：1.21 - 17.63）增加了围产期死亡的风险。27例（18.8%）病例出现病情复发，其中6例有多次复发，羟氯喹与病情复发减少相关（OR：0.15，95%CI：0.03 - 0.71）。
妊娠20周后，患有SLE的孕妇比无SLE的孕妇发生不良胎儿-母亲结局的风险更高。狼疮性肾炎和HDP增加了围产期死亡的风险，而使用羟氯喹可减少狼疮病情复发。
