scholarly journals High-risk factors for adverse pregnancy outcomes in systemic lupus erythaematosus: a retrospective study of a Chinese population

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e049807
Author(s):  
Meng Jiang ◽  
Yanling Chang ◽  
You Wang ◽  
Qiong Fu ◽  
Sihan Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Pregnancy Outcomes ◽  
Premature Birth ◽  
Twin Pregnancy ◽  
Immunosuppressive Agents ◽  
Systemic Lupus ◽  
Foetal Loss ◽  
High Risk Factors ◽  
Adverse Pregnancy

ObjectiveTo clarify high-risk factors for adverse pregnancy outcomes (APOs) in systemic lupus erythaematosus (SLE).DesignA retrospective chart review study.SettingData were collected in a tertiary medical centre, Shanghai, China, from November 2010 to December 2018.ParticipantsA total of 513 pregnancies with SLE were retrospectively analysed. Twenty-seven patients who underwent artificial abortions due to personal reasons were excluded.Primary outcome measuresAPOs were primary outcomes, including foetal loss, premature birth, small for gestational age (SGA), asphyxia neonatorum, composite foetal APOs and hypertensive disorders of pregnancy (HDP). Multivariable logistic regression and Spearman correlation analysis were performed to determine the risk factors for APOs in SLE.ResultsRisk factors for foetal loss included prepregnancy hypertension, hypocomplementaemia-C3, anticardiolipin antibodies-IgM positivity and disease flares during pregnancy. Risk factors for premature birth included disease flares, use of immunosuppressive agents and HDP. Moreover, twin pregnancy, disease flares and HDP were risk factors for SGA, and prepregnancy hypertension was an independent risk factor for asphyxia neonatorum. Independent risk factors for composite foetal APOs included twin pregnancy, prepregnancy hypertension, disease flares during pregnancy, HDP, hypocomplementaemia-C3 and the use of immunosuppressive agents. Risk factors for SLE complicated with HDP included prepregnancy hypertension, renal disorders and thrombocytopaenia. Conversely, the use of aspirin was a protective factor against foetal loss and premature birth. The ds-DNA value had a low diagnostic value for APOs, whereas the extent of complement reduction may predict the incidence of composite foetal APOs and foetal loss. Proteinuria occurring in the first 20 gestational weeks may lead to APOs.ConclusionEstablished risk factors for each APO were identified in this study. Indicators with more predictive significance have been screened out from conventional indicators, which may help clinicians predict the pregnancy outcome of patients with SLE more accurately and minimise the incidence of APOs.

scholarly journals Pre-pregnancy high-risk factors at first antenatal visit: how predictive are these of pregnancy outcomes?

2014 ◽  
pp. 1011 ◽  
Author(s):  
Barthélémy Tandu-Umba ◽  
Andy Mbangama Muela ◽  
Marc Brunel Kamongola Kitenge ◽  
Armel Georges Kamgang Tchawou ◽  
Perthus Kivuidi Mawamfumu ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Pregnancy Outcomes ◽  
Antenatal Visit ◽  
High Risk Factors

Do adverse pregnancy outcomes contribute to accelerated cardiovascular events seen in young women with systemic lupus erythematosus?

Lupus ◽  
2017 ◽  
Vol 26 (13) ◽  
pp. 1351-1367 ◽  
Author(s):  
M C Soh ◽  
C Nelson-Piercy ◽  
M Westgren ◽  
L McCowan ◽  
D Pasupathy
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Young Women ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Cardiovascular Events ◽  
Adverse Pregnancy Outcomes ◽  
Systemic Lupus ◽  
Adverse Pregnancy

Cardiovascular events (CVEs) are prevalent in patients with systemic lupus erythematosus (SLE), and it is the young women who are disproportionately at risk. The risk factors for accelerated cardiovascular disease remain unclear, with multiple studies producing conflicting results. In this paper, we aim to address both traditional and SLE-specific risk factors postulated to drive the accelerated vascular disease in this cohort. We also discuss the more recent hypothesis that adverse pregnancy outcomes in the form of maternal–placental syndrome and resultant preterm delivery could potentially contribute to the CVEs seen in young women with SLE who have fewer traditional cardiovascular risk factors. The pathophysiology of how placental-mediated vascular insufficiency and hypoxia (with the secretion of placenta-like growth factor (PlGF) and soluble fms-tyrosine-like kinase-1 (sFlt-1), soluble endoglin (sEng) and other placental factors) work synergistically to damage the vascular endothelium is discussed. Adverse pregnancy outcomes ultimately are a small contributing factor to the complex pathophysiological process of cardiovascular disease in patients with SLE. Future collaborative studies between cardiologists, obstetricians, obstetric physicians and rheumatologists may pave the way for a better understanding of a likely multifactorial aetiological process.

THU0273 DISEASE ACTIVITY IS IMPORTANT RISK FACTORS FOR MATERNAL AND FETAL OUTCOMES DURING PREGNANCY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 363-363
Author(s):  
J. W. Kim ◽  
J. Y. Jung ◽  
H. A. Kim ◽  
C. H. Suh
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Odds Ratio ◽  
Systemic Lupus ◽  
Steroid Dose ◽  
Adverse Pregnancy

Background:Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and disease activity frequently increase during pregnancy. Patient with SLE still have markedly higher risk for obstetric complications, despite discussing reproductive planning with physicians and choosing a suitable time for pregnancy.Objectives:This study aimed to examine the frequency and risk factors of complications occurring during pregnancy for women with SLE and compare with the general obstetric population.Methods:The medical records of patients with SLE and age-matched controls at Ajou University Hospital between January 1999 and June 2019 were collected and retrospectively analyzed. Clinical features and pregnancy complications for all pregnancy-related admissions for women with and without SLE were compared. Multivariate logistic regression analysis was performed to obtain the predictor of maternal and fetal adverse outcomes.Results:During this period, we analyzed 163 pregnancies in patients with SLE and 596 pregnancies in general population. Of these, except for body mass index (BMI), no other significant differences regarding demographic characteristics were noted between the groups. Lupus patients delivered significantly earlier(37 weeks + 0 days vs. 37 weeks + 6 days, p<0.001) and experienced more stillbirth (odds ratio (OR) 12.8), pre-eclampsia (OR 4.2), preterm labor (OR 2.6), emergency cesarean section (OR 2.5) and intrauterine growth retardation (odds ratio: 2.4) than age-matched controls. Using logistic regression, thrombocytopenia, low complement levels, high proteinuria, anti-ds DNA antibody positivity and high SLE Disease Activity Index (SLEDAI) were associated with maternal and fetal complications, whereas high cumulative steroid dose after SLE onset, high median steroid dose during pregnancy and history of cyclophosphamide treatment were only correlated with maternal complications. The area under the curve for SLEDAI score of adverse pregnancy outcome was 0.726 (95% CI 0.65-0.81) and cumulative steroid dose after SLE onset and median steroid dose during pregnancy for maternal outcome were 0.658 (95% confidence interval (CI) 0.55-0.76) and 0.750 (95% CI 0.65-0.85). The optimal cut-off value for SLEDAI was 4 and cumulative and median steroid dose were 2750mg and 6mg, respectively.Conclusion:Pregnant women with SLE have a higher risk of adverse pregnancy outcomes. Pregnancies should be delayed until disease activity is well controls (SLEDAI<4) for longer than 6 months.References:[1]L-W Kwok, LS Tam, TY Zhu, et al., Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus. Lupus 2010;20:781-791[2]E Sugawara, M Kato, Y Fugieda, et al., Pregnancy outcomes in women with rheumatic disease: a real-world observational study in Japan. Lupus 2019;28:1407-1416[3]M Clowse, M Jamison, E Myers, et al., A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 2008;199:127.e1-127.e6Disclosure of Interests:None declared

Neonatal outcome in pregnant patients with antiphospholipid syndrome

2015 ◽  
Vol 43 (6) ◽  
Author(s):  
Katarina Jeremic ◽  
Aleksandar Stefanovic ◽  
Jelena Dotlic ◽  
Jelena Stojnic ◽  
Sasa Kadija ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Distress Syndrome ◽  
Pregnancy Outcome ◽  
Pregnancy Outcomes ◽  
Distress Syndrome ◽  
Adverse Pregnancy Outcome ◽  
Perinatal Asphyxia ◽  
Premature Delivery ◽  
Control Group ◽  
Adverse Pregnancy

AbstractThe study aim was to evaluate pregnancy outcomes in patients with antiphospholipid syndrome (APS) and to determine which clinical parameters present risk factors for adverse pregnancy outcomes in these patients.The study included 55 patients with APS treated at the Clinic for Ob/Gyn, Clinical Center of Serbia, from 2006 to 2012. The control group consisted of 55 healthy pregnant women. Data regarding previous pregnancies and conception method were registered. Immunological and laboratory tests were performed. Pregnancy outcomes, including miscarriage, intrauterine fetal death, hypertensive disorders, diabetes mellitus, phlebothrombosis, fetal growth restriction, premature delivery, delivery method, perinatal asphyxia, respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis were followed.The premature delivery rate in APS patients was 31.8%, and pregnancy loss was 18.2%. Significantly more patients with APS had thrombocytopenia, pregnancy losses, intrauterine growth restriction, and perinatal asphyxia compared with the control group. More miscarriages, preterm delivery, lower birth weight, preeclampsia, and IgM anticardiolipin antibody levels significantly correlated with adverse pregnancy outcomes. Although rare, respiratory distress syndrome can also worsen neonatal health status. According to ROC analysis, previous miscarriages correctly explained 66.3% of adverse pregnancy outcome cases. We generated four equations of adverse pregnancy outcome risk factors.The most important prognostic factor for pregnancy outcome in APS patients is the number of previous miscarriages. Using appropriate current therapeutic protocol can enable live birth of a healthy newborn in most cases.

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