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Hoirisch-Clapauch S. The Impact of Emotional Responses on Female Reproduction: Fibrinolysis in the Spotlight. Semin Thromb Hemost 2025; 51:401-411. [PMID: 39029520 DOI: 10.1055/s-0044-1788324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
Fibrinolytic enzymes modify various substrates required for tissue remodeling, playing a crucial role in mechanisms underlying resilience, reward processing, ovulation, embryo implantation, and placentation. Individuals with low resilience and reduced reward responsiveness, when exposed to chronic stress, are at increased risk of experiencing a range of negative emotions. Chronic anxiety and melancholia are examples of negative emotions associated with hypercortisolism, while fear and atypical depression are characterized by systemic inflammation. Both cortisol and inflammatory cytokines stimulate the production of plasminogen activator inhibitor-1 (PAI-1), a potent fibrinolysis inhibitor. Chronic anxiety, fear, and depression are among the many hypofibrinolytic conditions increasing the risk of oligo-anovulation, miscarriage, fetal growth restriction, and preeclampsia. Although significant, the impact of negative emotions on implantation is not as obvious as on ovulation or placentation. Other hypofibrinolytic conditions that may affect female reproduction through mechanisms dependent or independent of PAI-1 include metabolic disturbances (e.g., due to consumption of highly palatable foods, often used to alleviate negative affect), inflammation, hyperhomocysteinemia, hypothyroidism, hypercortisolism, antiphospholipid antibodies, and the 4G allele of the PAI-1 gene. Benzodiazepines and antidepressants should be used with caution in the first trimester as this combination may cause malformations. Also, selective serotonin reuptake inhibitors have fibrinolytic properties that increase the risk of bleeding after surgical procedures. Psychological interventions, especially group therapy, are effective in the prevention of reproductive disorders. Controlled trials are needed to test the hypothesis that female reproductive health depends on psychological well-being, a balanced diet and physical activity, suppression of inflammation and autoantibodies, and homocysteine and hormonal homeostasis.
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Affiliation(s)
- Silvia Hoirisch-Clapauch
- Hematology Department, Vascular Medicine, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
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Cajamarca-Baron J, Sanmiguel-Reyes C, Bedoya-Loaiza JE, Castañeda-Gonzalez JP, Acelas-Gonzalez GE, Molina-Giraldo S, Guavita-Navarro D, Ibáñez C, Escobar A, Rojas-Villarraga A. Maternal and fetal outcomes in Latin American SLE pregnancies: A systematic review and meta-analysis. Autoimmun Rev 2025; 24:103744. [PMID: 39809408 DOI: 10.1016/j.autrev.2025.103744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 01/08/2025] [Accepted: 01/09/2025] [Indexed: 01/16/2025]
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) predominantly affects women, especially during their reproductive years, leading to increased risks during pregnancy. Latina women develop SLE at a younger age, which increases their susceptibility to pregnancy complications such as pre-eclampsia, preterm birth and fetal growth restriction. OBJECTIVE The purpose of this study is to systematically review maternal and fetal outcomes in pregnant Latina women with SLE and to perform a meta-analysis to assess specific risks associated with the disease. MATERIALS AND METHODS A systematic review according to PRISMA guidelines was performed (PubMed and SciELO), including studies on SLE and pregnancy in Latin America through December 2022. Eligible studies included case reports, cohort studies and clinical trials in pregnant women with SLE. The meta-analysis focused on key outcomes, including pre-eclampsia and lupus nephritis, with relative risk (RR) calculations. RESULTS Forty-four studies with 2190 pregnancies were included. High rates of pre-eclampsia (11-52 %), preterm delivery (18.6-70.8 %), and fetal loss were reported. A decades-long analysis of pregnancy outcomes in SLE in Latin America shows increased research and improved care, with fetal loss rates decreasing from 35 % (1980-1999) to lower intrauterine (28 %) and neonatal (10 %) death rates in 2020-2023. Meta-analysis showed that lupus nephritis almost doubled the risk of pre-eclampsia (RR = 1.89, 95 % CI:1.40-2.55) compared to women without nephritis. CONCLUSION Latina women with SLE are at increased risk for adverse pregnancy outcomes, particularly pre-eclampsia and preterm delivery. Lupus nephritis and disease activity are major risk factors, highlighting the need for tailored care and early intervention to improve maternal and fetal outcomes in this population.
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Affiliation(s)
- Jairo Cajamarca-Baron
- Rheumatologist, Hospital San José. Research Professor - Research Institute, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá 111411, Colombia.
| | - Catalina Sanmiguel-Reyes
- Rheumatologist, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá 111411, Colombia.
| | | | | | - Gabriel E Acelas-Gonzalez
- Research Institute, Fundación Universitaria de Ciencias de la Salud (FUCS). Bogotá 111411, Colombia.
| | - Saulo Molina-Giraldo
- Fetal Therapy and Fetal Surgery Unit, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology Hospital de San José, Department of Obstetrics and Gynecology, Fundación Universitaria de Ciencias de la Salud - FUCS, Fetal Therapy and Surgery Research Network, FetoNetwork Bogotá, Colombia, 111411.
| | - Diana Guavita-Navarro
- Rheumatologist, Hospital San José. Fundación Universitaria de Ciencias de la Salud (FUCS) Bogotá, Colombia, 111411.
| | - Claudia Ibáñez
- Epidemiologist, Fundación Universitaria de Ciencias de la Salud (FUCS) Bogotá, Colombia, 111411.
| | - Alejandro Escobar
- Rheumatologist, Hospital San José. Fundación Universitaria de Ciencias de la Salud (FUCS) Bogotá, Colombia, 111411
| | - Adriana Rojas-Villarraga
- Rheumatologist, Research Professor - Research Institute Fundación Universitaria de Ciencias de la Salud - FUCS, Bogotá 111411, Colombia.
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Saavedra MÁ, Gracia-Aréchiga TS, Miranda-Hernández D, Sánchez A, Arrucha-Cozaya M, Cruz-Domínguez MDP. Active but not quiescent lupus nephritis during pregnancy is associated with a higher rate of adverse obstetric outcomes: Analysis of a prospective cohort. Int J Gynaecol Obstet 2024; 167:420-426. [PMID: 38736284 DOI: 10.1002/ijgo.15601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 04/08/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To compare the maternal-fetal/neonatal outcome in patients with systemic lupus erythematosus (SLE) with and without lupus nephritis (LN) in remission or with active disease. METHODS A prospective cohort of pregnant patients with SLE (ACR 1997 criteria) was studied from January 2009 to December 2021. Demographic, clinical, biochemical, and immunological variables as well as the usual maternal-fetal/neonatal complications were recorded. We compared four groups according to the status of SLE during pregnancy: patients with quiescent SLE without lupus nephritis, patients with active SLE without lupus nephritis, patients with quiescent lupus nephritis, and patients with active lupus nephritis. Statistical analysis included descriptive statistics, bivariate analysis, and Cox regression analysis. RESULTS A total of 439 pregnancies were studied, with a median age of 28 ± 6, SLE duration of 60 months (interquartile range 36-120). A higher frequency of maternal and fetal/neonatal complications was observed in patients with active SLE with or without lupus nephritis. Multivariate analysis showed that active LN was a risk factor for gestational hypertension (hazard ratios [HR] 1.95; 95% confidence intervals [CI]: 1.01-6.39), premature rupture of membranes (HR 3.56; 95% CI: 1.79-16.05) and more frequent cesarean section (HR 1.82; 95% CI: 1.13-2.94). CONCLUSION LN is associated with a higher frequency of maternal complications, especially in those patients with active disease during pregnancy, and those maternal complications had an impact on poor fetal/neonatal outcomes. Strict control and timely care of LN could improve the obstetric prognosis.
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Affiliation(s)
- Miguel Ángel Saavedra
- División de Investigación en Salud, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Tayde Sarahí Gracia-Aréchiga
- Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Dafhne Miranda-Hernández
- Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Antonio Sánchez
- Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - María Del Pilar Cruz-Domínguez
- Dirección de Educación e Investigación en Salud, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, México City, Mexico
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Rosta K, Heinzl F, Kuczwara V, Schindler S, Falcone V, Catic A, Riedmann M, Leitner H, Simader E, Ritschl V, Stamm T, Szlatinay A, Mandl P, Mazzucato-Puchner A. Pregnancy outcomes in patients with systemic lupus erythematosus compared to a high-risk tertiary cohort and to standard population from the Austrian birth registry. Acta Obstet Gynecol Scand 2024; 103:1820-1828. [PMID: 38943224 PMCID: PMC11324932 DOI: 10.1111/aogs.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Women with systemic lupus erythematosus (SLE) have a higher risk for fetal and maternal complications. We aimed to investigate maternal and fetal complications in pregnant women with SLE compared to a high-risk pregnancy cohort (HR) from a tertiary university center and a standard-risk general population (SR) from the Austrian Birth Registry. MATERIAL AND METHODS In this retrospective data analysis, we compared the incidence of fetal/neonatal and maternal complications of pregnancies and deliveries of women with SLE to age, body mass index and delivery date-matched high-risk pregnancies from the same department, a progressive tertiary obstetric center and to a group of women, who represent pregnancies with standard obstetric risk from the Austrian Birth Registry. RESULTS One hundred women with SLE were compared to 300 women with high-risk pregnancies and 207 039 women with standard-risk pregnancies. The incidence of composite maternal complications (preeclampsia, Hemolysis, Elevated Liver enzymes and Low Platelets [HELLP] syndrome, pregnancy-related hypertension, gestational diabetes mellitus, maternal death, thromboembolic events) was significantly higher in the SLE as compared to the SR group (28% vs. 6.28% SLE vs. SR, p = 0.001). There was no difference between the SLE and the HR groups (28% vs. 29.6% SLE vs. HR group, p = 0.80). The incidence of composite fetal complications (preterm birth before 37 weeks of gestation, stillbirths, birthweight less than 2500 g, fetal growth restriction, large for gestational age, admission to neonatal intensive care unit, 5-min Apgar <7) was also higher in the SLE than in the SR group (55% vs. 25.54% SLE vs. SR p < 0.001) while the higher incidence of adverse fetal outcome was detected in the HR than in the SLE group (55% vs. 75% SLE vs. HR group, p = 0.0005). CONCLUSIONS Although composite fetal risk is higher in the SLE group than in the general population, it is still significantly lower as compared to high-risk pregnant women at a tertiary obstetric center. Prepregnancy counseling of women with SLE should put fetal and maternal risk in perspective, not only in relation to healthy, low risk cohorts, but also compared to mixed HR populations.
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Affiliation(s)
- Klara Rosta
- Department of Obstetrics and Gynecology, Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Heinzl
- Department of Obstetrics and Gynecology, Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Valerie Kuczwara
- Department of Obstetrics and Gynecology, Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefanie Schindler
- Department of Obstetrics and Gynecology, Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Veronica Falcone
- Department of Obstetrics and Gynecology, Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Anja Catic
- Department of Obstetrics and Gynecology, Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Marina Riedmann
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Hermann Leitner
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Elisabeth Simader
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Center for Medical Data Science, Institute for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Tanja Stamm
- Center for Medical Data Science, Institute for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Alexandra Szlatinay
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Peter Mandl
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Antonia Mazzucato-Puchner
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
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Doğru Ş, Akkuş F, Ezveci H, Yaman FK, Parlak S, Metin ÜS, Bahçeci P, Acar A. Predictability of the Delta Neutrophil Index and Other Blood Parameters on Perinatal Outcomes in Pregnant Women With Systemic Lupus Erythematosus. Am J Reprod Immunol 2024; 92:e13894. [PMID: 38958243 DOI: 10.1111/aji.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/26/2024] [Accepted: 06/07/2024] [Indexed: 07/04/2024] Open
Abstract
PROBLEM This study aimed to evaluate the predictive value of delta neutrophil index (DNI), a peripheral blood parameter, on perinatal outcomes in pregnant women with systemic lupus erythematosus (SLE). METHOD OF STUDY One hundred eighty-one participants, 78 pregnant women with SLE, and 103 healthy pregnant women were included in this retrospective study. Peripheral blood parameters including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and DNI taken in the first trimester were compared between groups. RESULTS NLR, PLR, and DNI were significantly higher in the SLE group (p = 0.027, p = 0.007, p = 0.0001, respectively). The same parameters were not found to be significant in determining disease activity in pregnant women with SLE (p > 0.05). When the predictive value of DNI for SGA in pregnancies with SLE was evaluated by receiver operating characteristic curve (ROC), the area under the ROC curve (AUC) was 0.666 (95% CI; 0.544-0.788, p = 0.018) with 84.6% sensitivity, 53.8% specificity, 56.0% PPV, and 78.1% NPV at a cut-off value of 0.16. The predictive value of DNI according to ROC for stillbirth in pregnancies with SLE was AUC 0.731 (95% CI: 0.539-0.923, p = 0.019) with a cut-off value of 0.17, sensitivity of 90%, specificity of 51.5%, PPV of 58.5%, and NPV of 87.2%. CONCLUSIONS Although DNI's prediction of SGA and stillbirth in pregnant women with SLE is encouraging, it needs more evidence from prospective studies with larger series.
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Affiliation(s)
- Şükran Doğru
- Department of Obstetrics and Gynecology, Division of Perinatology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Fatih Akkuş
- Department of Obstetrics and Gynecology, Division of Perinatology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Huriye Ezveci
- Department of Obstetrics and Gynecology, Division of Perinatology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Fikriye Karanfil Yaman
- Department of Obstetrics and Gynecology, Division of Perinatology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Selman Parlak
- Department of Rheumatology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Ülfet Sena Metin
- Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Pelin Bahçeci
- Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Ali Acar
- Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
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Elfving P, Kariniemi S, Kautiainen H, Rantalaiho V, Virta LJ, Puolakka K, Laine MK. Pregnancies in patients with systemic lupus erythematosus during 2000-2018 in Finland: a case-control study. Rheumatol Int 2024; 44:1101-1109. [PMID: 38565771 PMCID: PMC11108866 DOI: 10.1007/s00296-024-05564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The aim was to investigate, how pregnancies proceed in patients with systemic lupus erythematosus (SLE) compared to their individually matched population controls. MATERIAL AND METHODS Adult incident SLE patients were identified from the register of new special reimbursement decisions for SLE drugs in 2000-2014. For each patient, 1-3 randomly selected controls from the Population Register Centre were matched. Data regarding pregnancies were obtained from the Finnish Medical Birth Register, Care Register and Register of Congenital Malformations until 2018. The study utilized data from the Drug Purchase Register and educational information from Statistic Finland. RESULTS A total of 163 deliveries for 103 mothers with SLE and 580 deliveries for 371 population controls were identified. The duration of pregnancies in SLE women was significantly shorter compared to controls (38.9 versus 39.6 weeks). There were more urgent Caesarean Sections. (15% versus 9%) and need for care at neonatal intensive care unit (NICU) (21% versus 11%) among deliveries in SLE mothers. No statistical difference was observed between SLE and control groups in the occurrence of preeclampsia or major congenital malformations. Gestational age was 2.5 weeks shorter when the mother experienced pre-eclampsia. Hydroxychloroquine was purchased by 30% of SLE mothers during pregnancy. CONCLUSION The course of pregnancies in Finnish SLE patients seems to be quite moderate compared to controls, and no new safety issues were detected. The low utilization of hydroxychloroquine indicates that the benefits of the drug to pregnancy and disease course are not optimally recognized by specialists treating SLE mothers.
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Affiliation(s)
- Pia Elfving
- Department of Medicine, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland.
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Simo Kariniemi
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Vappu Rantalaiho
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
- Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Lauri J Virta
- Research Department, Social Insurance Institution, Helsinki, Finland
| | | | - Merja K Laine
- Folkhälsan Research Centre, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Dai Q, Li M, Tian X, Song Y, Zhao J. Predictive Factors for the Common Adverse Maternal and Fetal Outcomes in Pregnancies Complicated by Systemic Lupus Erythematosus. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:434-443. [PMID: 39035137 PMCID: PMC11257104 DOI: 10.1089/whr.2023.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 07/23/2024]
Abstract
Objectives This study aimed to evaluate the outcomes of pregnancy in patients with systemic lupus erythematosus (SLE). It focused on identifying clinical and laboratory markers that could predict the common adverse pregnancy outcomes (APOs) after 20 weeks of gestation, namely preeclampsia (PE) and preterm birth (PTB) in them. Methods Pregnant SLE women who delivered at the study center from 2010 to 2023 were retrospectively analyzed. Categorical variables were evaluated using the chi-square test or Fisher's exact test, while continuous variables underwent Mann-Whitney U testing. Stepwise regression was used to assess the predictors of pregnancy outcomes. Results The study enrolled 445 pregnancies in 408 women diagnosed with SLE. Of these, 202 pregnancies (45.4%) resulted in at least one APO. Disease flare-ups, hypertension, and proteinuria during the first trimester were primary predictors of at least one APO and PTB. The most frequently recorded maternal adverse outcome was PE (14.6%), while PTB accounted for 32.6% of fetal adverse outcomes. Multivariate regression analysis identified hypertension, history of PE, associated antiphospholipid syndrome (APS), proteinuria, and low serum C4 in the first trimester as independent risk factors for PE. Regular follow-ups at our center correlated with lower risks of APOs, PE, and PTB. APS also emerged as a risk factor for PTB, whereas the use of hydroxychloroquine (HCQ) during pregnancy seemed to protect against PTB. Conclusion For pregnancies complicated by SLE, we recommend early pregnancy screening for proteinuria-even in the absence of lupus nephritis-as well as continued use of HCQ and routine prenatal care throughout pregnancy.
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Affiliation(s)
- Qianwen Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Mengtao Li
- Dept of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xinping Tian
- Dept of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yijun Song
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Jiuliang Zhao
- Dept of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Cozzi GD, Battarbee AN, Sanjanwala AR, Casey BM, Subramaniam A. Association of Maternal Medical Comorbidities with Duration of Expectant Management in Patients with Severe Preeclampsia. Am J Perinatol 2024; 41:e1521-e1530. [PMID: 37072011 PMCID: PMC10582202 DOI: 10.1055/s-0043-1768232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE This study aimed to estimate the association between number of maternal comorbidities and duration of expectant management and perinatal outcomes in patients with preeclampsia with severe features. STUDY DESIGN Retrospective cohort of patients with preeclampsia with severe features delivering live, nonanomalous singletons at 23 to 342/7 weeks' gestation at a single center from 2016 to 2018. Patients delivered for an indication other than severe preeclampsia were excluded. Patients were categorized based on the number (0, 1, or ≥2) of comorbidities present: chronic hypertension, pregestational diabetes, chronic kidney disease, and systemic lupus erythematosus. The primary outcome was proportion of potential expectant management time achieved, that is, days of expectant management achieved divided by total potential expectant management time (days from severe preeclampsia diagnosis to 340/7 weeks). Secondary outcomes included delivery gestational age, days of expectant management, and perinatal outcomes. Outcomes were compared in bivariable and multivariable analyses. RESULTS Of 337 patients included, 167 (50%) had 0, 151 (45%) had 1, and 19 (5%) had ≥2 comorbidities. Groups differed with respect to age, body mass index, race/ethnicity, insurance, and parity. The median proportion of potential expectant management achieved in this cohort was 1.8% (interquartile range: 0-15.4), and did not differ by number of comorbidities (adjusted β: 5.3 [95% confidence interval [CI]: -2.1 to 12.9] for 1 comorbidity vs. 0 and adjusted β: -2.9 [95% CI: -18.0 to 12.2] for ≥2 comorbidities vs. 0). There was no difference in delivery gestational age or duration of expectant management in days. Patients with ≥2 (vs. 0) comorbidities had higher odds of composite maternal morbidity (adjusted odds ratio: 3.0 [95% CI: 1.1-8.2]). There was no association between number of comorbidities and composite neonatal morbidity. CONCLUSION Among patients with preeclampsia with severe features, the number of comorbidities was not associated with duration of expectant management; however, patients with ≥2 comorbidities had higher odds of adverse maternal outcomes. KEY POINTS · Greater number of medical comorbidities were not associated with expectant management duration.. · Two or more medical comorbidities were associated with higher odds of adverse maternal outcomes.. · Expectant management should be undertaken cautiously in medically complicated patients..
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Affiliation(s)
- Gabriella D. Cozzi
- Division of Maternal Fetal Medicine Center for Women’s Reproductive Health, University of Alabama at Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama
| | - Ashley N. Battarbee
- Division of Maternal Fetal Medicine Center for Women’s Reproductive Health, University of Alabama at Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama
| | - Aalok R. Sanjanwala
- Division of Maternal Fetal Medicine Center for Women’s Reproductive Health, University of Alabama at Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama
| | - Brian M. Casey
- Division of Maternal Fetal Medicine Center for Women’s Reproductive Health, University of Alabama at Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama
| | - Akila Subramaniam
- Division of Maternal Fetal Medicine Center for Women’s Reproductive Health, University of Alabama at Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama
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Singh M, Wambua S, Lee SI, Okoth K, Wang Z, Fayaz FFA, Eastwood KA, Nelson-Piercy C, Reynolds JA, Nirantharakumar K, Crowe F. Autoimmune diseases and adverse pregnancy outcomes: an umbrella review. BMC Med 2024; 22:94. [PMID: 38438886 PMCID: PMC10913233 DOI: 10.1186/s12916-024-03309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/19/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND There is a high prevalence of autoimmune conditions in women specially in the reproductive years; thus, the association with adverse pregnancy outcomes has been widely studied. However, few autoimmune conditions/adverse outcomes have been studied more than others, and this umbrella review aims to consolidate existing knowledge in this area with the aim to provide new knowledge and also identify gaps in this research area. METHODS Medline, Embase, and Cochrane databases were searched from inception to December 2023. Screening, data extraction, and quality appraisal (AMSTAR 2) were done by two independent reviewers. Data were synthesised narratively and quantitatively. Relative risks (RR)/odds ratio (OR) with 95% confidence intervals were reported. RESULTS Thirty-two reviews were included consisting of 709 primary studies. The review reported the association between 12 autoimmune conditions and 16 adverse pregnancy outcomes. Higher risk of miscarriage is reported in women with Sjögren's syndrome RR 8.85 (95% CI 3.10-25.26) and systemic lupus erythematosus (SLE) OR 4.90 (3.10-7.69). Pre-eclampsia was reported higher in women with type 1 diabetes mellitus (T1DM) OR 4.19 (3.08-5.71) and SLE OR 3.20 (2.54-4.20). Women reported higher risk of diabetes during pregnancy with inflammatory bowel disease (IBD) OR 2.96 (1.47-5.98). There was an increased risk of intrauterine growth restriction in women with systemic sclerosis OR 3.20 (2.21-4.53) and coeliac disease OR 1.71 (1.36-2.14). Preterm birth was associated with T1DM OR 4.36 (3.72-5.12) and SLE OR 2.79 (2.07-3.77). Low birth weight babies were reported in women with women with SLE or systemic sclerosis OR 5.95 (4.54-7.80) and OR 3.80 (2.16-6.56), respectively. There was a higher risk of stillbirth in women with T1DM OR 3.97 (3.44-4.58), IBD OR 1.57 (1.03-2.38), and coeliac disease OR 1.57 (1.17-2.10). T1DM in women was associated with 32% lower odds of small for gestational age baby OR 0.68 (0.56-0.83). CONCLUSIONS Pregnant women with autoimmune conditions are at a greater risk of developing adverse pregnancy outcomes. Further research is required to develop better preconception to postnatal care for women with autoimmune conditions.
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Affiliation(s)
- Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Wambua
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zhaonan Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Kelly-Ann Eastwood
- Centre for Public Health, University of Belfast, Belfast, Queen, BT7 1NN, UK
- Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8EG, UK
| | | | - John A Reynolds
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Francesca Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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10
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Xie F, Agrawal S, Johnson EF, Wieland CN, Davis DMR, Theiler RN, Lehman JS. Updates on the dermatopathology of pregnancy-associated skin conditions. Hum Pathol 2023; 140:173-195. [PMID: 37209919 DOI: 10.1016/j.humpath.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
Pathologists provide valuable input in the dermatological care of pregnant patients in various contexts. This article provides dermatopathology updates on cutaneous changes associated with pregnancy, organized based on the following classification system: physiological skin changes in pregnancy, specific dermatoses of pregnancy, dermatoses modified in pregnancy, and skin neoplasms in pregnancy. Awareness of the impact of pregnancy on the skin by pathologists is important, as this is an opportunity to contribute to diagnostic precision in this patient population.
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Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Shruti Agrawal
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dawn Marie R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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11
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Laíño-Piñeiro MC, Rúa-Figueroa I, Jiménez N, Lozano MJC, Martínez-Barrio J, Serrano B, Galindo-Izquierdo M, Nack A, Loricera J, Tomero-Muriel E, Ibáñez-Barceló M, Vázquez NM, Manrique-Arija S, Lorenzo NA, Narváez J, Rosas J, Menor-Almagro R, Martínez-Taboada VM, Aurrecoechea-Aguinaga E, Horcada L, Ruiz-Lucea E, Raya E, Toyos FJ, Expósito L, Vela P, Freire-González M, Moriano-Morales C, Bonilla-Hernán G, Ibáñez TC, Lozano-Rivas N, Moreno M, Andreu JL, Ubiaga CLI, Torrente-Segarra V, Valls E, Velloso-Feijoo ML, Alcázar JL, Pego-Reigosa JM. Pregnancy outcomes in 1869 pregnancies in a large cohort from the Spanish Society of Rheumatology Lupus Register (RELESSER). Semin Arthritis Rheum 2023; 61:152232. [PMID: 37348350 DOI: 10.1016/j.semarthrit.2023.152232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/15/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Obstetric complications are more common in women with systemic lupus erythematosus (SLE) than in the general population. OBJECTIVE To assess pregnancy outcomes in women with SLE from the RELESSER cohort after 12 years of follow-up. METHODS A multicentre retrospective observational study was conducted. In addition to data from the RELESSER register, data were collected on obstetric/gynaecological variables and treatments received. The number of term pregnancies was compared between women with pregnancies before and after the diagnosis of SLE. Further, clinical and laboratory characteristics were compared between women with pregnancies before and after the diagnosis, on the one hand, and with and without complications during pregnancy, on the other. Bivariate and multivariate analyses were carried out to identify factors potentially associated with complications during pregnancy. RESULTS A total of 809 women were included, with 1869 pregnancies, of which 1395 reached term. Women with pregnancies before the diagnosis of SLE had more pregnancies (2.37 vs 1.87) and a higher rate of term pregnancies (76.8% vs 69.8%, p < 0.001) compared to those with pregnancies after the diagnosis. Women with pregnancies before the diagnosis were diagnosed at an older age (43.4 vs 34.1 years) and had more comorbidities. No differences were observed between the groups with pregnancies before and after diagnosis in antibody profile, including anti-dsDNA, anti-Sm, anti-Ro, anti-La, lupus anticoagulant, anticardiolipin or anti-beta-2-glycoprotein. Overall, 114 out of the 809 women included in the study experienced complications during pregnancy, including miscarriage, preeclampsia/eclampsia, foetal death, and/or preterm birth. Women with complications had higher rates of antiphospholipid syndrome (40.5% vs 9.9%, p < 0.001) and higher rates of positivity for IgG anticardiolipin (33.9% vs 21.3%, p = 0.005), IgG anti-beta 2 glycoprotein (26.1% vs 14%, p = 0.007), and IgM anti-beta 2 glycoprotein (26.1% vs 16%, p = 0.032) antibodies, although no differences were found regarding lupus anticoagulant. Among the treatments received, only heparin was more commonly used by women with pregnancy complications. We did not find differences in corticosteroid or hydroxychloroquine use. CONCLUSIONS The likelihood of term pregnancy is higher before the diagnosis of SLE. In our cohort, positivity for anticardiolipin IgG and anti-beta-2- glycoprotein IgG/IgM, but not lupus anticoagulant, was associated with a higher risk of poorer pregnancy outcomes.
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Affiliation(s)
| | - Iñigo Rúa-Figueroa
- Department of Rheumatology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Norman Jiménez
- IRIDIS Group (Investigation in Rheumatology and Immune-Diseases), Galicia Sur Health Research Institute (IISGS), Vigo, Spain
| | | | | | - Belén Serrano
- Department of Rheumatology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Annika Nack
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Javier Loricera
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Eva Tomero-Muriel
- Department of Rheumatology, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Natalia Mena Vázquez
- Department of Rheumatology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Manrique-Arija
- Department of Rheumatology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Nerea Alcorta Lorenzo
- Department of Rheumatology, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - José Rosas
- Department of Rheumatology, Hospital Marina Baixa, Alicante, Spain
| | - Raúl Menor-Almagro
- Department of Rheumatology, Hospital Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | | | - Loreto Horcada
- Department of Rheumatology, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Enrique Raya
- Department of Rheumatology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - F Javier Toyos
- Department of Rheumatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Lorena Expósito
- Department of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | | | - Tatiana Cobo Ibáñez
- Department of Rheumatology, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Nuria Lozano-Rivas
- Department of Rheumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mireia Moreno
- Department of Rheumatology, Hospital Universitario Parc Taulí, Sabadell, Spain
| | - José Luis Andreu
- Department of Rheumatology, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Vicenç Torrente-Segarra
- Department of Rheumatology, Hospital Comarcal Alt Penedès-Garraf, Vilafranca del Penedès, Spain
| | - Elia Valls
- Department of Rheumatology, Hospital Dr. Peset, Valencia, Spain
| | - M L Velloso-Feijoo
- Department of Rheumatology, Hospital Universitario de Valme, Sevilla, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José M Pego-Reigosa
- IRIDIS Group (Investigation in Rheumatology and Immune-Diseases), Galicia Sur Health Research Institute (IISGS), Vigo, Spain; Department of Rheumatology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
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12
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Tabacco S, Ambrosii S, Polsinelli V, Fantasia I, D’Alfonso A, Ludovisi M, Cecconi S, Guido M. Pre-Eclampsia: From Etiology and Molecular Mechanisms to Clinical Tools-A Review of the Literature. Curr Issues Mol Biol 2023; 45:6202-6215. [PMID: 37623210 PMCID: PMC10453909 DOI: 10.3390/cimb45080391] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Pre-eclampsia is a severe pregnancy-related complication that manifests as a syndrome with multisystem involvement and damage. It has significantly grown in frequency during the past 30 years and could be considered as one of the major causes of maternal and fetal morbidity and mortality. However, the specific etiology and molecular mechanisms of pre-eclampsia are still poorly known and could have a variety of causes, such as altered angiogenesis, inflammations, maternal infections, obesity, metabolic disorders, gestational diabetes, and autoimmune diseases. Perhaps the most promising area under investigation is the imbalance of maternal angiogenic factors and its effects on vascular function, though studies in placental oxidative stress and maternal immune response have demonstrated intriguing findings. However, to determine the relative importance of each cause and the impact of actions aiming to significantly reduce the incidence of this illness, more research is needed. Moreover, it is necessary to better understand the etiologies of each subtype of pre-eclampsia as well as the pathophysiology of other major obstetrical syndromes to identify a clinical tool able to recognize patients at risk of pre-eclampsia early.
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Affiliation(s)
- Sara Tabacco
- Unit of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Silvia Ambrosii
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Valentina Polsinelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Ilaria Fantasia
- Unit of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Angela D’Alfonso
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Manuela Ludovisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Sandra Cecconi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Maurizio Guido
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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13
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Monti P, Solazzo G, Accurti V, Gambitta B, Iodice S, Boito S, Cantone L, Manenti A, Dioni L, Montomoli E, Persico N, Bollati V. Pyroptosis: A Promising Mechanism Linking SARS-CoV-2 Infection to Adverse Pregnancy Outcomes. Int J Mol Sci 2023; 24:ijms24119278. [PMID: 37298229 DOI: 10.3390/ijms24119278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Pregnancy is characterized by a delicate immune balance; therefore, infectious diseases might increase the risk of adverse pregnancy outcomes (APOs). Here, we hypothesize that pyroptosis, a unique cell death pathway mediated by the NLRP3 inflammasome, could link SARS-CoV-2 infection, inflammation, and APOs. Two blood samples were collected from 231 pregnant women at 11-13 weeks of gestation and in the perinatal period. At each time point, SARS-CoV-2 antibodies and neutralizing antibody titers were measured by ELISA and microneutralization (MN) assays, respectively. Plasmatic NLRP3 was determined by ELISA. Fourteen miRNAs selected for their role in inflammation and/or pregnancy were quantified by qPCR and further investigated by miRNA-gene target analysis. NLRP3 levels were positively associated with nine circulating miRNAs, of which miR-195-5p was increased only in MN+ women (p-value = 0.017). Pre-eclampsia was associated with a decrease in miR-106a-5p (p-value = 0.050). miR-106a-5p (p-value = 0.026) and miR-210-3p (p-value = 0.035) were increased in women with gestational diabetes. Women giving birth to small for gestational age babies had lower miR-106a-5p and miR-21-5p (p-values = 0.001 and 0.036, respectively), and higher miR-155-5p levels (p-value = 0.008). We also observed that neutralizing antibodies and NLRP3 concentrations could affect the association between APOs and miRNAs. Our findings suggest for the first time a possible link between COVID-19, NLRP3-mediated pyroptosis, inflammation, and APOs. Circulating miRNAs might be suitable candidates to gain a comprehensive view of this complex interplay.
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Affiliation(s)
- Paola Monti
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Giulia Solazzo
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Veronica Accurti
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Bianca Gambitta
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Simona Iodice
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Simona Boito
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Laura Cantone
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | | | - Laura Dioni
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Emanuele Montomoli
- VisMederi Srl, 53100 Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Nicola Persico
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- CRC, Center for Environmental Health, University of Milan, 20122 Milan, Italy
| | - Valentina Bollati
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- CRC, Center for Environmental Health, University of Milan, 20122 Milan, Italy
- Occupational Health Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy
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14
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Zhang S, Han X, Liu W, Wen Q, Wang J. Pregnancy in patients with systemic lupus erythematosus: a systematic review. Arch Gynecol Obstet 2022; 308:63-71. [PMID: 35913558 DOI: 10.1007/s00404-022-06718-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
Abstract
Systemic lupus erythematosus (SLE)-a most common disorder in women of reproductive age-has been described to be associated with adverse pregnancy outcomes. Despite the increased health risks for the mother (preeclampsia, lupus flare, arterial hypertension, gestational diabetes mellitus and thrombotic risk when antiphospholipid antibodies are present) and fetus (miscarriage, stillbirth, premature birth, intrauterine growth restriction and neonatal lupus), the majority of patients can deliver healthy neonates. With appropriate management by a multidisciplinary team, composing rheumatologists, obstetricians and neonatologists, women with SLE can achieve better pregnancy outcomes by monitoring associated predictive indicators, raising major concern for severe complications and somewhat early delivery if necessary. In this review, we summarize the latest advances in secondary infertility and pregnancy-related risk perception for lupus patients, with an emphasis on the safety of biological agents (mainly belimumab and rituximab) and traditional therapeutic regimens.
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Affiliation(s)
- Shumin Zhang
- Department of Rheumatiod and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Xiao Han
- Department of Rheumatiod and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Wenping Liu
- Department of Rheumatiod and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Qiong Wen
- Department of Rheumatiod and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Jibo Wang
- Department of Rheumatiod and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China.
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15
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Sugai S, Suda K, Tamegai K, Haino K, Nakatsue T, Narita I, Enomoto T, Nishijima K. Massive ascites due to lupus peritonitis in a patient with pre-eclampsia and systemic lupus erythematosus: a case report. BMC Pregnancy Childbirth 2022; 22:203. [PMID: 35287623 PMCID: PMC8919585 DOI: 10.1186/s12884-022-04550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with systemic lupus erythematosus (SLE) are associated with pre-eclampsia. Pre-eclampsia can have systemic manifestations, such as ascites. Lupus peritonitis, a rare condition in patients with SLE, can also cause ascites. CASE PRESENTATION A 31-year-old woman, primigravida, with SLE had a blood pressure of 170/110 mmHg and proteinuria at 29 weeks of gestation. She was diagnosed with pre-eclampsia. Her blood pressure was stabilized by an antihypertensive drug. At 30 weeks of gestation, a cesarean section was performed for maternal safety because of decreased urine output and massive ascites. Postoperatively, re-accumulation of ascites was observed. On the fourth postoperative day, ascites (approximately 3 L) was discharged from the cesarean section wound. A decrease in serum complement concentrations was observed, and she was diagnosed as having lupus peritonitis. The steroid dose was increased and she recovered well thereafter. CONCLUSIONS Ascites occurs in pre-eclampsia and SLE, but determining which of these conditions causes ascites can be difficult. However, careful observation is necessary because of the differences in treatment of these two conditions.
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Affiliation(s)
- Shunya Sugai
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan.
| | - Kazuaki Suda
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
| | - Kana Tamegai
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
| | - Kazufumi Haino
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
| | - Takeshi Nakatsue
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koji Nishijima
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
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16
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Sole KB, Staff AC, Räisänen S, Laine K. Substantial decrease in preeclampsia prevalence and risk over two decades: A population-based study of 1,153,227 deliveries in Norway. Pregnancy Hypertens 2022; 28:21-27. [PMID: 35151209 DOI: 10.1016/j.preghy.2022.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Analyze secular trends of preeclampsia in Norway based on risk factors. STUDY DESIGN Population-based cohort study of 1,153,227 women using data from Medical Birth Registry of Norway from 1999 to 2018. Aggregated data from Norwegian Prescription Database from 2004 to 2018 were used. Main exposure variable was time period. Descriptive statistics identified the prevalence of preeclampsia, labor induction and aspirin use. Multiple logistic regression analysis was performed to estimate the risk of preeclampsia during the time periods. MAIN OUTCOME MEASURES Preeclampsia. RESULTS Overall preeclampsia prevalence decreased from 4.3% in 1999-2002 to 2.7% in 2015-2018. A reduction was observed in all subgroups of women with known risk factors (age, nulliparity, diabetes, chronic hypertension, assisted reproduction, twin pregnancy). Adjusted risk of preeclampsia was reduced by 44% from 1999-2002 to 2015-2018 (aOR = 0.56, 95%CI 0.54, 0.58), while the net prevalence of gestational hypertension remained stable over the study period. Labor induction increased 104%. Aspirin prescriptions increased among fertile women in the general Norwegian population. CONCLUSIONS Preeclampsia prevalence and risk were reduced regardless of risk factors and despite an increased proportion of high-risk parturients (advanced age, lower parity, use of assisted reproduction). A corresponding increase in aspirin prescriptions among fertile women and an overall increase in labor inductions were also observed, suggesting that clinical interventions may partly explain the observed reduction in preeclampsia prevalence. Lower average blood pressure and improved health in the population may also explain some of the reduction.
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Affiliation(s)
- Kristina B Sole
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway.
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Sari Räisänen
- School of Health, Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland
| | - Katariina Laine
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway; Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
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17
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Jung E, Romero R, Yeo L, Gomez-Lopez N, Chaemsaithong P, Jaovisidha A, Gotsch F, Erez O. The etiology of preeclampsia. Am J Obstet Gynecol 2022; 226:S844-S866. [PMID: 35177222 PMCID: PMC8988238 DOI: 10.1016/j.ajog.2021.11.1356] [Citation(s) in RCA: 234] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 02/08/2023]
Abstract
Preeclampsia is one of the "great obstetrical syndromes" in which multiple and sometimes overlapping pathologic processes activate a common pathway consisting of endothelial cell activation, intravascular inflammation, and syncytiotrophoblast stress. This article reviews the potential etiologies of preeclampsia. The role of uteroplacental ischemia is well-established on the basis of a solid body of clinical and experimental evidence. A causal role for microorganisms has gained recognition through the realization that periodontal disease and maternal gut dysbiosis are linked to atherosclerosis, thus possibly to a subset of patients with preeclampsia. The recent reports indicating that SARS-CoV-2 infection might be causally linked to preeclampsia are reviewed along with the potential mechanisms involved. Particular etiologic factors, such as the breakdown of maternal-fetal immune tolerance (thought to account for the excess of preeclampsia in primipaternity and egg donation), may operate, in part, through uteroplacental ischemia, whereas other factors such as placental aging may operate largely through syncytiotrophoblast stress. This article also examines the association between gestational diabetes mellitus and maternal obesity with preeclampsia. The role of autoimmunity, fetal diseases, and endocrine disorders is discussed. A greater understanding of the etiologic factors of preeclampsia is essential to improve treatment and prevention.
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Affiliation(s)
- Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Detroit Medical Center, Detroit, MI.
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI
| | - Piya Chaemsaithong
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Faculty of Medicine, Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Adithep Jaovisidha
- Faculty of Medicine, Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Francesca Gotsch
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, HaEmek Medical Center, Afula, Israel
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18
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Erazo-Martínez V, Nieto-Aristizábal I, Ojeda I, González M, Aragon CC, Zambrano MA, Tobón GJ, Arango J, Echeverri A, Aguirre-Valencia D. Systemic erythematosus lupus and pregnancy outcomes in a Colombian cohort. Lupus 2021; 30:2310-2317. [PMID: 34874750 DOI: 10.1177/09612033211061478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Pregnant women with SLE have higher probabilities of maternal complications. SLE during pregnancy has alternating patterns of remission and flare-ups; however, most pregnant SLE patients tend to worsen with associated poor obstetric and perinatal outcomes. This study aimed to describe obstetric outcomes in pregnant women with SLE. METHODS This retrospective study was performed between 2011 and 2020 at a highly complex referral health center in Cali, Colombia. Pregnant women with a diagnosis of SLE were included. Demographic, clinical, and laboratory features and obstetric and fetal outcomes, including intensive care unit (ICU) characteristics, were evaluated. RESULTS Forty-eight pregnant women with SLE were included. The median age was 29 (25-33.7) years. The SLE diagnosis was made before pregnancy in 38 (79.1%) patients, with a median disease duration of 46 (12-84) months. Thirteen (27.1%) patients had lupus nephritis. Preterm labor (34, 70.8%), preeclampsia (25, 52%), and preterm rupture of membranes (10, 20.8%) were the most common obstetric complications. A relationship between a greater systemic lupus erythematosus pregnancy disease activity index (SLEPDAI) and the development of hypertensive disorders during pregnancy was established (preeclampsia = p < 0.0366; eclampsia = p < 0.0153). A relationship was identified between lupus nephritis (LN) and eclampsia (p < 0.01), preterm labor (p < 0.045), and placental abruption (p < 0.01). Seventeen (35.4%) patients required ICU admission; 52.9% of them were due to AID activity, 17.6% for cardiovascular damage, 11.7% for septic shock, and 5.8% for acute kidney failure. Fetal survival was 89.5% (N = 43/48). Among the live births, two (4.2%) newborns were diagnosed with neonatal lupus, and two (4.2%) were diagnosed with congenital heart block. One maternal death was registered due to preeclampsia and intraventricular hemorrhage. CONCLUSIONS This study is the first to describe SLE during pregnancy in Colombia. SLE was the most prevalent AID in this cohort, and complications included preterm labor, preeclampsia, and postpartum hemorrhage. A higher SLEPDAI and lupus nephritis predicted adverse maternal outcomes.
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Affiliation(s)
| | | | - Isabella Ojeda
- Facultad de Ciencias de la Salud, 28012Universidad Icesi, Cali, Colombia
| | - Michelle González
- Facultad de Ciencias de la Salud, 28012Universidad Icesi, Cali, Colombia
| | - Cristian C Aragon
- CIRAT: Centro de Investigación en Reumatología, 28012Universidad Icesi, Autoinmunidad y Medicina Traslacional, Cali, Colombia
| | - María Andrea Zambrano
- Centro de Investigaciones Clínicas, 67597Fundación Valle del Lili, Cali, Colombia.,CIRAT: Centro de Investigación en Reumatología, 28012Universidad Icesi, Autoinmunidad y Medicina Traslacional, Cali, Colombia
| | - Gabriel J Tobón
- CIRAT: Centro de Investigación en Reumatología, 28012Universidad Icesi, Autoinmunidad y Medicina Traslacional, Cali, Colombia.,Unidad de Reumatología, 67597Fundación Valle del Lili, Cali, Colombia
| | - Johanna Arango
- Unidad de Gineco-obstetricia, 67597Fundación Valle del Lili, Cali, Colombia
| | - Alex Echeverri
- Unidad de Reumatología, 67597Fundación Valle del Lili, Cali, Colombia
| | - David Aguirre-Valencia
- Facultad de Ciencias de la Salud, 28012Universidad Icesi, Cali, Colombia.,Unidad de Reumatología, 67597Fundación Valle del Lili, Cali, Colombia
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Jiang M, Chang Y, Wang Y, Fu Q, Lin S, Wu J, Di W. High-risk factors for adverse pregnancy outcomes in systemic lupus erythaematosus: a retrospective study of a Chinese population. BMJ Open 2021; 11:e049807. [PMID: 34785549 PMCID: PMC8596043 DOI: 10.1136/bmjopen-2021-049807] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To clarify high-risk factors for adverse pregnancy outcomes (APOs) in systemic lupus erythaematosus (SLE). DESIGN A retrospective chart review study. SETTING Data were collected in a tertiary medical centre, Shanghai, China, from November 2010 to December 2018. PARTICIPANTS A total of 513 pregnancies with SLE were retrospectively analysed. Twenty-seven patients who underwent artificial abortions due to personal reasons were excluded. PRIMARY OUTCOME MEASURES APOs 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. RESULTS Risk 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. CONCLUSION Established 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.
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Affiliation(s)
- Meng Jiang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
| | - Yanling Chang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
| | - You Wang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
| | - Qiong Fu
- Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Institute of Rheumatology, Shanghai, China
| | - Sihan Lin
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
| | - Jiayue Wu
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
| | - Wen Di
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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20
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Abstract
PURPOSE OF REVIEW People with childbearing capacity who are diagnosed with systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS) have specific and important reproductive health considerations. RECENT FINDINGS Recommendations from the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) provide rheumatologists and other clinicians with guidance for reproductive health management of patients with rheumatic diseases. Patient-centered reproductive health counseling can help clinicians to operationalize the EULAR and ACR guidelines and enhance patient care. SUMMARY Disease activity monitoring, risk factor stratification, and prescription of pregnancy-compatible medications during pregnancy help to anticipate complications and enhance pregnancy outcomes in SLE and SS. Assisted reproductive technologies are also safe among people with well-controlled disease. Safe and effective contraceptive methods are available for patients with SLE and SS, and pregnancy termination appears to be safe among these patients.
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21
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Miranda-Hernández D, Sánchez A, Sánchez-Briones RE, Rivas-Ruiz R, Cruz-Reynoso L, Cruz-Domínguez P, Jara LJ, Saavedra MÁ. Impact of Systemic Lupus Erythematosus on Pregnancy: Analysis of a Large 10-Year Longitudinal Mexican Cohort. J Clin Rheumatol 2021; 27:S217-S223. [PMID: 33264243 DOI: 10.1097/rhu.0000000000001626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pregnancy in patients with systemic lupus erythematosus is considered a high risk one since it is associated with a higher rate of maternal-fetal complications compared with the pregnancies in healthy women. OBJECTIVES The aim of this study was to describe the maternal-fetal outcomes in a cohort of Mexican patients with systemic lupus erythematosus and to identify risk factors associated with adverse maternal and fetal outcomes. PATIENTS AND METHODS A cohort of pregnant lupus patients was analyzed. Maternal-fetal complications were described, and clinical, biochemical, and immunological variables associated with obstetric adverse outcomes were studied. Descriptive statistics, comparison of variables using appropriate tests, and finally logistic regression analysis were performed to identify potential risk factors for adverse maternal and fetal outcomes. RESULTS A total of 351 pregnancies were included in a 10-year period. The most frequently observed maternal adverse outcomes were lupus flare (35%) and preeclampsia (14.5%). Active lupus before pregnancy (hazards ratio [HR], 3.7; 95% confidence interval [CI], 1.1-12.5; p = 0.003) was a predictor for these complications, whereas the use of antimalarial drugs (HR, 0.4; 95% CI, 0.2-0.7; p = 0.007) was a protective factor. The most frequent fetal adverse outcomes were preterm birth (38.1%), miscarriages (10%), and low birth weight babies (28%), and very low birth weight newborns (11%). Proteinuria in early pregnancy (HR, 7.1; 95% CI, 1.01-50.3; p = 0.04) and preeclampsia (HR, 9.3; 95% CI, 1.7-49.7; p = 0.009) were risk factors associated with these complications. CONCLUSIONS Variables related to systemic lupus erythematosus activity predict an adverse maternal outcome, whereas proteinuria in early pregnancy and preeclampsia are associated with an adverse fetal outcome.
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Affiliation(s)
- Dafhne Miranda-Hernández
- From the Rheumatology Unit, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza
| | - Antonio Sánchez
- From the Rheumatology Unit, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza
| | - Reyna E Sánchez-Briones
- From the Rheumatology Unit, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza
| | | | | | | | - Luis Javier Jara
- Direction of Education and Health Research, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Miguel Ángel Saavedra
- From the Rheumatology Unit, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza
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22
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Xie W, Huang H, Ji L, Zhang Z. Maternal and Neonatal Outcomes in Pregnant Women with Psoriasis and Psoriatic Arthritis: A Systematic Review and Meta-Analysis. Rheumatology (Oxford) 2021; 60:4018-4028. [PMID: 33878171 DOI: 10.1093/rheumatology/keab357] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/11/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Psoriasis and psoriatic arthritis (PsA) are inflammatory diseases that affect women in their reproductive years. We aimed to investigate whether maternal psoriasis and PsA are associated with adverse pregnancy outcomes. METHODS We searched multiple electronic databases from inception to 3 August 2020, and reference lists of selected articles. Observational studies reporting at least one pregnancy outcomes in women with psoriasis or PsA with a comparator of general population or healthy subjects were included. Data were pooled by random-effects models and expressed as odds ratio (OR) and 95% confidence interval (CI). RESULTS Overall, 16 studies were included in the meta-analysis. The pooled analyses showed pregnant women with psoriatic diseases have significantly higher risk of adverse maternal outcomes compared with general population (caesarean delivery: 1.33 (1.17-1.52); preterm birth: 1.32 (1.15-1.52); (pre)eclampsia: 1.28 (1.14-1.43); gestational diabetes: 1.19 (1.10-1.30); gestational hypertension: 1.30 (1.18-1.44). However, no statistically increased risks of fetal complications were observed in women with psoriatic diseases (small for gestational age: 1.02 (0.93-1.11); low birth weight: 1.15 (0.93-1.42); congenital malformations: 1.03 (0.93-1.14); Apgar score <7: 1.07 (0.81-1.39); neonatal mortality: 1.13 (0.90-1.43); stillbirth: 1.19 (0.95-1.50)). Subgroup analysis found similar results in women with either psoriasis or PsA regarding maternal outcomes and the magnitude of risk estimates seems to be greater in PsA though without statistical difference. CONCLUSIONS Pregnant women with psoriasis and PsA have excess risk of adverse maternal events, but not adverse neonatal events. Close monitoring of the mothers' clinical status before and during pregnancy is decidedly required in daily practice.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China
| | - Hong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China
| | - Lanlan Ji
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China
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23
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Bovbjerg ML. Current Resources for Evidence-Based Practice, March 2021. J Obstet Gynecol Neonatal Nurs 2021; 50:225-236. [PMID: 33607061 DOI: 10.1016/j.jogn.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of men's experiences of pregnancy loss and commentaries on reviews focused on the effects of perineal massage on perineal trauma and air pollution and heat exposure on birth outcomes.
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Abstract
Current research in the field of systemic lupus erythematosus (SLE) and pregnancy focuses on predictors of adverse pregnancy outcomes, the safety and efficacy of hydroxychloroquine (HCQ) in pregnancy and the importance of preconception counselling. In particular, the prospective predictors of pregnancy outcome: biomarkers in antiphospholipid antibody syndrome and SLE (PROMISSE) study adds to the understanding of risk factors for adverse outcomes. There is increasing evidence of the numerous benefits associated with continuing HCQ treatment in pregnancy and for the use of low-dose acetylsalicylic acid in the prevention of preeclampsia. The European League Against Rheumatism (EULAR) has published evidence-based recommendations for the treatment of women with SLE and/or antiphospholipid syndrome before, during and after pregnancy. Rheumatologists caring for women with SLE should be familiar with the current state of knowledge in order to help optimize the management and thus the outcome of pregnancy in their patients.
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Affiliation(s)
- R Fischer-Betz
- Poliklinik für Rheumatologie und Hiller Forschungszentrum, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - I Haase
- Poliklinik für Rheumatologie und Hiller Forschungszentrum, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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