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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: 0] [Impact Index Per Article: 0] [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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Wang X, Li J, Liang Q, Ni X, Zhao R, Fu T, Ji J, Li L, Gu Z, Dong C. Reproductive concerns and contributing factors in women of childbearing age with systemic lupus erythematosus. Clin Rheumatol 2022; 41:2383-2391. [PMID: 35386049 DOI: 10.1007/s10067-022-06156-5] [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: 01/17/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Reproductive concerns are common in women of childbearing age with systemic lupus erythematosus (SLE) with inadequate disclosure. This study aimed to investigate the contributing factors of reproductive concerns and to evaluate their impact on health-related quality of life. METHODS One hundred eighty women of childbearing age with SLE were enrolled in this cross-sectional study in Affiliated Hospital of Nantong University from March 2021 to December 2021. A series of questionnaires were conducted: Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Fatigue Inventory (MFI-20), Female Sexual Distress Scale-Revised (FSDS-R), Family Assessment Device (APGAR), the Medical Coping Modes Questionnaire (MCMQ), the Short-Form 36 (SF-36), and the Chinese version of Reproductive Concerns After Cancer (RCAC). Independent t test, one-way ANOVA, Mann-Whitney U test, Pearson/Spearman, and multiple linear stepwise regression were used to analyze the data. RESULTS The results indicated that female SLE patients were more concerned about the child's health and personal health than becoming pregnant, fertility potential, partner disclose and acceptance; SLE patients with the characteristics of living in rural residence, having no reproductive history, fearing unexpected pregnancy, sexual distress, and depression showed more serious fertility concerns. Meanwhile, most female SLE patients adopted active confrontation when facing reproductive concerns, and these patients were significantly lower in the dimension score of mental related quality of life. CONCLUSIONS Our study demonstrated that female SLE patients should be paid more attention to their fertility concerns and effective intervention measures should be carried out to relieve their reproductive concerns, so as to improve their long-term quality of life if their disease condition permits.
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Affiliation(s)
- Xingxin Wang
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, People's Republic of China
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Jingjing Li
- Department of Emergency, Affiliated Hospital of Nantong University, Nantong, 226001, People's Republic of China
| | - Qian Liang
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, People's Republic of China
| | - Xiaowei Ni
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, People's Republic of China
| | - Rui Zhao
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, People's Republic of China
| | - Ting Fu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, People's Republic of China
| | - Juan Ji
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, People's Republic of China
| | - Liren Li
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, 226001, People's Republic of China
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, People's Republic of China.
| | - Chen Dong
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, People's Republic of China.
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