1
|
Tripathi PU, Patvekar MM, Suryarao P, Ghotankar SS. In Vitro Fertilisation and Systemic Lupus Erythematosus: Making The Correct Choice. Cureus 2024; 16:e60100. [PMID: 38860088 PMCID: PMC11164295 DOI: 10.7759/cureus.60100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/11/2024] [Indexed: 06/12/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that increases the risk of complications in pregnancy. SLE flares during pregnancy are attributed to higher levels of estrogen and other cytokines. A 34-year-old woman with SLE, who had undergone in vitro fertilization (IVF), was diagnosed with a lupus flare at 14 weeks of gestation. Prior to conception, it is essential to evaluate disease activity, major organ complications, hypercoagulability, and any other medical conditions that could affect pregnancy outcomes in women with SLE in order to prevent adverse results. Additionally, the presence of anti-phospholipid antibodies (APLA) should be ruled out before considering assisted reproductive techniques (ART). After conception, optimal and vigilant monitoring is essential. A multidisciplinary team and approach should be employed throughout pregnancy to manage disease progression and identify any further complications. In conclusion, effective counseling and clear explanations of risks and benefits are pivotal in empowering the patient to make an informed decision.
Collapse
Affiliation(s)
- Pankti U Tripathi
- Obstetrics and Gynaecology, Dr. DY Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Meenal M Patvekar
- Obstetrics and Gynaecology, Dr. DY Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Prashant Suryarao
- Obstetrics and Gynaecology, Dr. DY Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Shambhavi S Ghotankar
- Central Research Facility, Dr. DY Patil Medical College, Hospital and Research Centre, Pune, IND
| |
Collapse
|
2
|
Shen G, Swaminathan M, Huang I, Louden D, Feterman D, Tahir MW, Singh N. Racial disparities in pregnancy outcomes among women with rheumatic diseases: A systematic literature review. Semin Arthritis Rheum 2023; 60:152193. [PMID: 36966601 PMCID: PMC10148907 DOI: 10.1016/j.semarthrit.2023.152193] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE There is a limited understanding of racial disparities in adverse pregnancy outcomes (APO) among women with rheumatic diseases. The aim of our study was to conduct a systematic literature review to evaluate the impact of race on APO in women with rheumatic diseases. METHODS Databases were searched to find reports of APO stratified by race among women with rheumatic diseases. The initial searches were conducted in July 2020 and updated in March 2021. Of the final included articles, the full text was reviewed, and data was extracted from each study using a standard data abstraction form. RESULTS Ten studies with a total of 39,720 patients met our eligibility criteria. There was a greater propensity for APO in racial minorities with rheumatic diseases compared to their White counterparts. Among women with systemic lupus erythematosus (SLE), Black women had the highest odds of APOs, particularly those with a concomitant diagnosis of antiphospholipid syndrome. Pooled meta-analysis could not be done due to multiple factors, including heterogeneity between studies. CONCLUSION Racial minorities with rheumatic diseases are more prone to APO compared to their White counterparts. One limitation is the lack of standardized criteria for APO, which prohibited direct comparison between studies. There is also a paucity of data looking at APOs among women with rheumatic diseases other than SLE. Further research is needed to explore the drivers of these racial disparities to guide targeted solutions for those in the greatest need.
Collapse
Affiliation(s)
- Gloria Shen
- University of Washington, Seattle, WA, United States
| | - Maya Swaminathan
- Division of Rheumatology, Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Irvin Huang
- Division of Rheumatology, Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Diana Louden
- University Libraries, University of Washington, Seattle, WA, United States
| | - Dominique Feterman
- Division of Rheumatology, Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Muhammad Waqas Tahir
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Namrata Singh
- Division of Rheumatology, Department of Internal Medicine, University of Washington, Seattle, WA, United States.
| |
Collapse
|
3
|
Mao R, Wang X, Long R, Wang M, Jin L, Zhu L. A new insight into the impact of systemic lupus erythematosus on oocyte and embryo development as well as female fertility. Front Immunol 2023; 14:1132045. [PMID: 37033965 PMCID: PMC10076658 DOI: 10.3389/fimmu.2023.1132045] [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: 12/26/2022] [Accepted: 03/14/2023] [Indexed: 04/11/2023] Open
Abstract
Background Systemic lupus erythematosus (SLE) is often associated with adverse reproductive outcomes. But it's currently unclear regarding the role of SLE in oocyte and embryonic development. Also, it's controversial whether SLE has an adverse effect on fertility. There is a lack of comprehensive understanding and assessment of fertility in patients with SLE. Objective This study was aim to investigate oocyte and embryonic development as well as ovarian reserve, and clinical outcomes in SLE patients during in vitro fertilization (IVF) treatment. By combining data on embryonic and gamete development in SLE patients, we hope to provide new insights into a comprehensive assessment of fertility in SLE patients. Methods In this study, we collected data from 34 SLE patients who were previously diagnosed and in remission for a total of 44 IVF cycles and matched 102 infertile women with a total of 148 IVF cycles by Propensity Score Matching (PSM) of 1:3 ratio. We then evaluated baseline characteristics, ovarian reserve, IVF laboratory outcomes, and clinical outcomes between the two groups. Results After PSM matching, baseline characteristics including age, infertility types, and duration, as well as infertility causes overall coincided between the two groups. Anti-müllerian hormone (AMH) was significantly lower in the SLE group vs comparison (1.9 vs. 3.3 ng/mL, P=0.001). The SLE group performed a significant reduction in available embryo rate (76.6% vs. 86.0%, P=0.001), good-quality blastocyst formation rate (35.1% vs. 47.0%, P=0.003), and blastocyst formation rate (51.0% vs. 67.7%, P=0.001) compared to the comparison. As for clinical outcomes, the implantation rate in the SLE group was notably lower (37.9% vs. 54.9%, P=0.022). The CLBR following every embryo-transfer procedure was distinctly lower (41.2% vs 64.7%, P=0.016) in the SLE group vs comparison. Also, the conservative and optimal CLBRs following every complete cycle procedure were significantly reduced in the SLE group vs the comparison (P=0.001, both). Conclusion Patients with SLE present worse outcomes in oocyte and embryonic development, thus yielding compromised female fertility and clinical pregnancy. Individualized fertility assessment and early fertility guidance are necessary for these special groups.
Collapse
Affiliation(s)
| | | | | | | | - Lei Jin
- *Correspondence: Lixia Zhu, ; Lei Jin,
| | - Lixia Zhu
- *Correspondence: Lixia Zhu, ; Lei Jin,
| |
Collapse
|
4
|
Girbash EF, Abdelwahab SM, Fahmi DS, Abdeldayem HM, Ghonaim R, Atta DS. Preliminary study on Anti‐Müllerian hormone, Antral follicle count, menstruation and lymphocyte subsets in systemic lupus erythematosus patients. Int J Gynaecol Obstet 2022; 159:129-135. [DOI: 10.1002/ijgo.14109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/18/2021] [Accepted: 01/20/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ehab F. Girbash
- Obstetrics & Gynecology Department, Faculty of Medicine ‐ Zagazig University
| | - Shaimaa M Abdelwahab
- Rheumatology & Rehabilitation Department, Faculty of Medicine ‐Zagazig University
| | - Dalia S Fahmi
- Rheumatology & Rehabilitation Department, Faculty of Medicine ‐Zagazig University
| | | | - Rania Ghonaim
- Clinical Pathology Department, Faculty of Medicine ‐Zagazig University
| | - Doaa S Atta
- Rheumatology & Rehabilitation Department, Faculty of Medicine ‐Zagazig University
| |
Collapse
|
5
|
Dos Santos FC, Ignacchiti ML, Rodrigues B, Velarde LG, Levy RA, de Jesús GR, de Jesús NR, de Andrade CAF, Klumb EM. Premature rupture of membranes - A cause of foetal complications among lupus: A cohort study, systematic review and meta-analysis. Lupus 2021; 30:2042-2053. [PMID: 34806483 DOI: 10.1177/09612033211045056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study aimed to analyse the frequency of premature rupture of membranes (PROMs) among 190 women with systemic lupus erythematosus (SLE) followed up at the Hospital Universitário Pedro Ernesto from 2011 to 2018 and to review the literature on PROM in patients with SLE. METHODS A cohort study of SLE patients was conducted by analysing the following variables: sociodemographic characteristics, clinical manifestations of lupus, modified disease activity index for pregnancy, drugs used during pregnancy, intercurrent maternal infections and obstetric outcomes. Additionally, seven electronic databases (PubMed, Embase, Cochrane, Scielo, Scielo Brazil, Virtual Health Library Regional Portal and Google Scholar) were systematically searched. The search was updated on 3 February 2020. RESULTS Infections (relative risk (RR): 3.26, 95% confidence interval (CI): 1.5-6.7, p = .001), history of serositis (RR: 2.59, 95% CI: 1.31-5.11, p = .006) and anti-RNP positivity (RR: 3.08, 95% CI: 1.39-6.78, p = .005) were associated risk factors for PROM, while anti-RNP positivity (RR: 3.37, 95% CI: 1.35-8.40; p = .009) were associated with premature PROM (PPROM). The prevalence of PROM and PPROM was 28.7% and 12.9%, respectively. In the systematic review, the prevalence of PROM and PPROM was 2.7%-35% (I2 = 87.62%) and 2.8%-20% (I2 = 79.56%), respectively. CONCLUSIONS PROM, both at term and preterm, occurs more frequently in women with lupus than in the general population. A history of serositis, anti-RN, infections and immunosuppression during pregnancy may increase the susceptibility to PROM. The systematic review did not find any study with the main objective of evaluating PROM/PPROM in women with lupus.
Collapse
Affiliation(s)
- Flávia Cunha Dos Santos
- Department of Obstetrics, 28130Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | | | - Bruna Rodrigues
- Department of Rheumatology, 28130Universidade do Estado Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | - Luis Guillermo Velarde
- Postgraduate Program in Medical Sciences, 28110Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Roger Abramino Levy
- Department of Rheumatology, 28130Universidade do Estado Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | | | - Nilson Ramires de Jesús
- Department of Obstetrics, 28130Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | - Carlos Augusto Ferreira de Andrade
- Department of Epidemiology, Quantitative Methods in Health, 42499Escola Nacional de Saúde Pública Sérgio Arouca, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Evandro Mendes Klumb
- Department of Rheumatology, 28130Universidade do Estado Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| |
Collapse
|
6
|
Chung MK, Park JS, Lim H, Lee CH, Lee J. Incidence and prevalence of systemic lupus erythematosus among Korean women in childbearing years: A nationwide population-based study. Lupus 2021; 30:674-679. [PMID: 33460342 DOI: 10.1177/0961203320984845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Most women with systemic lupus erythematosus (SLE) are diagnosed with the disease in their reproductive years, but the incidence and prevalence of SLE among women of childbearing age have not been studied. The objective of this study was to estimate the incidence and prevalence of SLE among the Korean women of childbearing age. METHODS Women aged 20 to 44 years with SLE were identified from National Health Insurance Service - National Health Information Database (2009-2016), which contain health information of approximately 97% of the Korean population. SLE was defined by International Classification of Diseases, 10th revision code, M32. Incidence and prevalence were calculated per 100,000 person-years and stratified by year and age. RESULTS A total of 12,756 women with SLE were identified. The incidence of SLE from 2011 to 2016 among women in childbearing years was 8.18/100,000 person-years (95% CI 7.94-8.43), with the highest incidence in 2016 (8.56/100,000 person-years, 95% CI 7.95-9.17) and the lowest incidence in 2012 (7.85/100,000 person-years, 95% CI 7.28-8.42). The prevalence of SLE from 2009 to 2016 among women in childbearing years was 77.07/100,000 person-years (95% CI 75.76-78.39), with the highest prevalence in 2014 (79.47/100,000 person-years, 95% CI 77.64-81.30) and the lowest in 2010 (74.19/100,000 person-years, 95% CI 72.45-75.93). The peak age for SLE incidence was between 25-39 years, and lower incidence was seen in the early (20-24 years) and late (40-44 years) childbearing age periods. There was an increasing trend in prevalence according to age in women of childbearing age, with the highest prevalence occurring in the 40-44 age group. CONCLUSIONS The risk and burden of SLE are high among women during their childbearing years. This calls for special attention to this particular population group when allocating health resources.
Collapse
Affiliation(s)
- Min Kyung Chung
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jin Su Park
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Hyunsun Lim
- Research and Analysis Team, National Health Insurance Service Ilsal Hospital, Goyang-si, South Korea
| | - Chan Hee Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jisoo Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea
| |
Collapse
|
7
|
Angley M, Lim SS, Spencer JB, Howards PP. Infertility Among African American Women With Systemic Lupus Erythematosus Compared to Healthy Women: A Pilot Study. Arthritis Care Res (Hoboken) 2020; 72:1275-1281. [PMID: 31282105 PMCID: PMC6946885 DOI: 10.1002/acr.24022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Some treatments for systemic lupus erythematosus (SLE) can cause infertility, but the effect of SLE itself on fertility, particularly in African American women, is less clear. We undertook this study to examine infertility experiences in African American women with SLE compared to healthy women. METHODS We enrolled women ages 22-40 years living in the Atlanta metropolitan area who were diagnosed with SLE after age 17 years. Women who had ever been treated with cyclophosphamide or who had a hysterectomy were excluded. African American women ages 22-40 years who were from the same area and recruited from a marketing list were used for comparison. Women were interviewed about their reproductive histories and goals. Periods of infertility were identified as times when women had regular, unprotected sex for ≥12 months without conceiving after 20 years of age. We separately considered any period of infertility and periods of infertility when attempting pregnancy. We used Cox proportional hazards regression to examine the association between SLE and time to infertility. Models were adjusted for age, nulliparity, and smoking. An age-matched analysis was also conducted to examine periods of infertility occurring after SLE diagnosis. RESULTS Our sample included 75 women with SLE and 154 women without SLE. SLE was associated with any infertility (adjusted hazard ratio [HRadj ] 2.08 [95% confidence interval (95% CI) 1.38-3.15]), but less so with infertility when attempting pregnancy (HRadj 1.30 [95% CI 0.62-2.71]). The matched analysis generated similar point estimates. CONCLUSION Women with SLE may be more likely to experience episodes of infertility, but this may not translate to an inability to meet reproductive goals.
Collapse
Affiliation(s)
- Meghan Angley
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - S. Sam Lim
- Department of Epidemiology, Rollins School of Public Health, Emory University
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine
| | - Jessica B. Spencer
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine
| | - Penelope P. Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University
| |
Collapse
|
8
|
Rezk M, Ellakwa H, Al-Halaby A, Shaheen A, Zahran A, Badr H. Predictors of poor obstetric outcome in women with systemic lupus erythematosus: a 10-year experience of a university hospital. J Matern Fetal Neonatal Med 2016; 30:2031-2035. [PMID: 27628505 DOI: 10.1080/14767058.2016.1236244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the maternal and fetal outcome in patients with systemic lupus erythematosus (SLE) by a retrospective analysis from 2005 to 2010, and a prospective follow-up of pregnant SLE patients from 2010 to 2015 to find out predictors of poor obstetric outcome. METHODS The study included 236 SLE pregnant females (retrospective group) whose data were viewed retrospectively from their medical records, and 214 SLE pregnant females (prospective group) who were followed prospectively to record their maternal and fetal outcome. RESULTS There was a highly significant difference between the two groups regarding abortion, venous thromboembolism, prematurity, and intrauterine fetal death (p < 0.001) with more occurrence in retrospective group. Also, the frequency of lupus flares, worsening of renal functions, blood transfusion, maternal mortality, admission to NICU, and neonatal death was higher in the retrospective group (p < 0.05). Predictors of poor obstetric outcome included Last flare before pregnancy <6 months, number of antenatal hospital admissions ≥ 6, use of immunosuppressive therapy, the presence of anti-SSA/Ro and anti-SSB/La, and SLE with nephritis (p < 0.05). CONCLUSION Improved maternal and fetal outcome in women with SLE has occurred following integrated multidisciplinary approach. This emphasizes the importance of postponing pregnancy when predictors of poor outcome are encountered.
Collapse
Affiliation(s)
| | | | | | | | | | - Hassan Badr
- c Department of Pediatrics , Faculty of Medicine, Menoufia University , Menoufia , Egypt
| |
Collapse
|
9
|
Fredi M, Gregorini G, Zatti S, Lojacono A, Tincani A. Identifying and managing lupus nephritis during pregnancy. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1228452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
10
|
Teh CL, Wan SA, Cheong YK, Ling GR. Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia. Lupus 2016; 26:218-223. [DOI: 10.1177/0961203316664996] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a 10-year period (2006–2015) to describe the clinical features, maternal and foetal outcomes in our centre. There were 115 pregnancies in 86 women with SLE. Our patients had a mean age of 29.1 years (SD 5.80) and a mean disease duration of 44.63 months (SD 41.17). Fifteen patients had antiphospholipid syndrome (APS). Our patients had complicated pregnancies: 26.1% had SLE flares, 13.9% had pre-eclampsia and 45.1% needed caesarean sections. There were 23.3% foetal losses and 25% preterm deliveries in our patients. There was a higher rate of unplanned pregnancies and lupus flare among pregnancies with active SLE at conception. Pregnancies in lupus nephritis have higher incidence of lupus flares during pregnancy but similar maternal and foetal outcomes compared to those without nephritis. The prognostic indicators for adverse foetal outcome in our patients were flare of SLE (HR 4.08 [CI 95% 1.65–10.13, p < 0.01]) and APS (HR 3.07 [CI 95% 1.12–8.42, p < 0.05]) and the prognostic indicator for adverse maternal outcome was hypertension (HR 3.58 [CI 95% 1.30–9.90, p < 0.05]). Lupus pregnancies in our centre remained as high-risk pregnancies with significant maternal and foetal complications.
Collapse
Affiliation(s)
- C L Teh
- Unit of Rheumatology, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - S A Wan
- Unit of Rheumatology, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Y K Cheong
- Unit of Rheumatology, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - G R Ling
- Unit of Rheumatology, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| |
Collapse
|
11
|
Lee JW, Park DJ, Kang JH, Choi SE, Yim YR, Kim JE, Lee KE, Wen L, Kim TJ, Park YW, Sung YK, Lee SS. The rate of and risk factors for frequent hospitalization in systemic lupus erythematosus: results from the Korean lupus network registry. Lupus 2016; 25:1412-1419. [PMID: 27000153 DOI: 10.1177/0961203316640916] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The survival rate of patients with systemic lupus erythematosus has improved in the last few decades, but the rate of hospitalization and health care costs for these patients remain higher than in the general population. Thus, we evaluated the rate of hospitalization and associated risk factors in an inception cohort of Korean patients with lupus. Methods Of the 507 patients with systemic lupus erythematosus enrolled in the KORean lupus NETwork, we investigated an inception cohort consisting of 196 patients with systemic lupus erythematosus presenting within 6 months of diagnosis based on the American College of Rheumatology classification criteria. We evaluated the causes of hospitalization, demographic characteristics, and laboratory and clinical data at the time of systemic lupus erythematosus diagnosis of hospitalized patients and during a follow-up period. We calculated the hospitalization rate as the number of total hospitalizations divided by the disease duration, and defined "frequent hospitalization" as hospitalization more than once per year. Results Of the 196 patients, 117 (59.6%) were admitted to hospital a total of 257 times during the 8-year follow-up period. Moreover, 22 (11.2%) patients were hospitalized frequently. The most common reasons for hospitalization included disease flares, infection, and pregnancy-related morbidity. In the univariate regression analysis, malar rash, arthritis, pericarditis, renal involvement, fever, systemic lupus erythematosus disease activity index > 12, hemoglobin level < 10 mg/dl, albumin level < 3.5 mg/dl, and anti-Sjögren's syndrome A positivity were associated with frequent hospitalization. Finally, multivariate analysis showed that arthritis, pericarditis, and anti-Sjögren's syndrome A antibody positivity at the time of diagnosis were risk factors for frequent hospitalization. Conclusions Our results showed that frequent hospitalization occurred in 11.2% of hospitalized patients and arthritis, pericarditis, and anti-Sjögren's syndrome A antibody positivity at the time of diagnosis were risk factors for frequent hospitalization.
Collapse
Affiliation(s)
- J W Lee
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - D J Park
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - J H Kang
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - S E Choi
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Y R Yim
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - J E Kim
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - K E Lee
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - L Wen
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - T J Kim
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Y W Park
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Y K Sung
- 2 Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - S S Lee
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| |
Collapse
|
12
|
Kim IJ, Kim HA, Suh CH, Park YW, Lee HS, Bang SY, Bae SC, Kang YM, Lee WK, Park H, Lee J. Impact of Childbearing Decisions on Family Size of Korean Women with Systemic Lupus Erythematosus. J Korean Med Sci 2016; 31:729-34. [PMID: 27134494 PMCID: PMC4835598 DOI: 10.3346/jkms.2016.31.5.729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/21/2016] [Indexed: 11/20/2022] Open
Abstract
Systemic lupus erythematosus (SLE) predominantly affects women in their reproductive years and has a significant impact on childbearing. We investigated the influence of personal decision on family size among Korean women with SLE and factors that affect the decisions. A case-control study comparing childbearing history and decisions of 112 SLE patients and 135 controls was performed. Women with SLE participating in the Network for Lupus Clinical Research in South Korea and matching controls between ages of 18-45, who are/were married or living with a partner were included. Data regarding socio-demographics, reproductive history, and childbearing decisions were collected through a survey using a standardized questionnaire and medical record review. More women with SLE reported at least one pregnancy (85.7% vs. 71.9%, P = 0.009) or at least one live birth (85.7% vs. 71.9%, P = 0.003) compared with controls. Mean number of pregnancies was significantly higher (2.4 ± 1.6 vs. 1.4 ± 1.3, P < 0.001), and mean number of live births was significantly lower in women with SLE (1.2 ± 0.8 vs. 1.6 ± 0.8, P < 0.001). Significantly more women with SLE made the decision not to have children compared with controls (54.5% vs. 40.7%, P = 0.031), and health-related concerns were the major cause of the decision. Other socio-demographic factors did not influence the decision to limit childbearing in SLE women. The disease-related concerns had significant impact on family size and childbearing decisions among Korean women with SLE.
Collapse
Affiliation(s)
- In Je Kim
- Department of Rheumatology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Yong-Wook Park
- Department of Rheumatology, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Hye-Soon Lee
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - So-Young Bang
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Young Mo Kang
- Department of Rheumatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Won Kyung Lee
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hyesook Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jisoo Lee
- Department of Rheumatology, Ewha Womans University School of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Wallenius M, Salvesen KÅ, Daltveit AK, Skomsvoll JF. Secular trends of pregnancies in women with inflammatory connective tissue disease. Acta Obstet Gynecol Scand 2015; 94:1195-202. [DOI: 10.1111/aogs.12722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 07/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Marianne Wallenius
- National Advisory Unit on Pregnancy and Rheumatic Diseases; Department of Rheumatology; Trondheim University Hospital; Trondheim Norway
- Department of Neuroscience; Norwegian University of Science and Technology; Trondheim Norway
| | - Kjell Å. Salvesen
- National Center for Fetal Medicine; Department of Obstetrics and Gynecology; Trondheim University Hospital; Trondheim Norway
- Department of Laboratory Medicine; Women's and Child Health; Norwegian University of Science and Technology; Trondheim Norway
| | - Anne K. Daltveit
- Department of Global Public Health and Primary Health Care; University of Bergen; Bergen Norway
- Medical Birth Registry of Norway; Division of Epidemiology; Norwegian Institute of Public Health; Bergen Norway
| | - Johan F. Skomsvoll
- National Advisory Unit on Pregnancy and Rheumatic Diseases; Department of Rheumatology; Trondheim University Hospital; Trondheim Norway
| |
Collapse
|
14
|
Understanding and Managing Pregnancy in Patients with Lupus. Autoimmune Dis 2015; 2015:943490. [PMID: 26246905 PMCID: PMC4515284 DOI: 10.1155/2015/943490] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/31/2015] [Indexed: 12/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that occurs predominantly in women of fertile age. The association of SLE and pregnancy, mainly with active disease and especially with nephritis, has poorer pregnancy outcomes, with increased frequency of preeclampsia, fetal loss, prematurity, growth restriction, and newborns small for gestational age. Therefore, SLE pregnancies are considered high risk condition, should be monitored frequently during pregnancy and delivery should occur in a controlled setting. Pregnancy induces dramatic immune and neuroendocrine changes in the maternal body in order to protect the fetus from immunologic attack and these modifications can be affected by SLE. The risk of flares depends on the level of maternal disease activity in the 6–12 months before conception and is higher in women with repeated flares before conception, in those who discontinue useful medications and in women with active glomerulonephritis at conception. It is a challenge to differentiate lupus nephritis from preeclampsia and, in this context, the angiogenic and antiangiogenic cytokines are promising. Prenatal care of pregnant patients with SLE requires close collaboration between rheumatologist and obstetrician. Planning pregnancy is essential to increase the probability of successful pregnancies.
Collapse
|
15
|
Wallenius M, Salvesen KÅ, Daltveit AK, Skomsvoll JF. Systemic lupus erythematosus and outcomes in first and subsequent births based on data from a national birth registry. Arthritis Care Res (Hoboken) 2014; 66:1718-24. [PMID: 24839126 DOI: 10.1002/acr.22373] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 05/13/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the associations between systemic lupus erythematosus (SLE) and outcomes in first and subsequent births. METHODS Data from the Medical Birth Registry of Norway during the period December 1, 1998 to December 31, 2009 were used to assess maternal and perinatal outcomes in women diagnosed with SLE compared with the general population. Outcomes of first and subsequent births were analyzed separately. Associations between SLE and pregnancy outcomes were assessed in logistic regression analyses and are shown as adjusted odds ratios (aORs) after adjustment for maternal age, gestational age, smoking habits, and previous cesarean section (CS), when relevant. RESULTS We analyzed 95 first and 145 subsequent births in patients and compared them with references. The risk of CS was two-fold higher in SLE patients in first and subsequent births. More newborns of patients had a birth weight <2,500 gm (aOR 5.00 [95 % confidence interval (95% CI) 3.02, 8.27] in first births and aOR 4.33 [95% CI 2.64, 7.10] in subsequent births). Additionally, preterm birth was more frequent among SLE patients (aOR 4.04 [95% CI 2.45, 6.56] in first births and aOR 3.13 [95% CI 1.97, 4.98] in subsequent births). Congenital malformations were more prevalent among children of patients than references (aOR 2.71 [95% CI 1.25, 5.86] in first births and aOR 3.13 [95% CI 1.69, 5.79] in subsequent births). Perinatal death was more frequent in first births among patients (aOR 7.34 [95% CI 2.69, 20.03]), but no difference was observed in subsequent births. CONCLUSION Pregnancy complications were more frequent in SLE patients than references, and the greatest differences between groups were observed in first births.
Collapse
Affiliation(s)
- Marianne Wallenius
- Trondheim University Hospital and Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | |
Collapse
|
16
|
|
17
|
Poulton K, Ripoll VM, Pericleous C, Meroni PL, Gerosa M, Ioannou Y, Rahman A, Giles IP. Purified IgG from patients with obstetric but not IgG from non-obstetric antiphospholipid syndrome inhibit trophoblast invasion. Am J Reprod Immunol 2014; 73:390-401. [PMID: 25469631 PMCID: PMC4409084 DOI: 10.1111/aji.12341] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/28/2014] [Indexed: 02/06/2023] Open
Abstract
PROBLEM Some patients with antiphospholipid syndrome (APS) suffer pregnancy morbidity (PM) but not vascular thrombosis (VT), whilst others suffer VT only. Therefore, we compared the effects of IgG from VT+/PM- and VT-/PM+ subjects on human first-trimester trophoblast (HTR8) cells. METHOD OF STUDY HTR-8 cells were incubated with APS VT+/PM-, APS VT-/PM+ or healthy control (HC) IgG. We measured trophoblast invasion by cell invasion assay; mRNA expression of TLR4 and adaptor proteins; phosphorylation of p38 MAPK, NFκB and ERK; and expression of interleukin (IL)-8 and IL-6. RESULTS VT-/PM+ IgG, but not VT+/PM- IgG significantly reduced HTR-8 invasion. The effects on invasion were blocked by TLR-4 inhibition. Neither VT+/PM- nor VT-/PM+ IgG altered MyD88 mRNA expression, phosphorylation of signalling molecules or cytokine expression. CONCLUSIONS VT-/PM+ IgG exert functionally relevant effects on human trophoblast cells but VT+/PM- IgG do not.
Collapse
Affiliation(s)
- Katie Poulton
- Division of Medicine, Centre for Rheumatology, Rayne Institute, University College London (UCL), London, UK
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Park EJ, Jung H, Hwang J, Kim H, Lee J, Ahn JK, Cha HS, Koh EM. Pregnancy outcomes in patients with systemic lupus erythematosus: a retrospective review of 62 pregnancies at a single tertiary center in South Korea. Int J Rheum Dis 2014; 17:887-97. [DOI: 10.1111/1756-185x.12435] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eun-Jung Park
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Hyemin Jung
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jiwon Hwang
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Hyungjin Kim
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jaejoon Lee
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Joong Kyong Ahn
- Division of Rheumatology; Department of Medicine; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Hoon-Suk Cha
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Eun-Mi Koh
- Division of Rheumatology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| |
Collapse
|
19
|
Pego-Reigosa JM, Cobo-Ibáñez T, Calvo-Alén J, Loza-Santamaría E, Rahman A, Muñoz-Fernández S, Rúa-Figueroa Í. Efficacy and safety of nonbiologic immunosuppressants in the treatment of nonrenal systemic lupus erythematosus: a systematic review. Arthritis Care Res (Hoboken) 2014; 65:1775-85. [PMID: 23609987 DOI: 10.1002/acr.22035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 03/27/2013] [Accepted: 04/12/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To analyze the efficacy and safety of nonbiologic immunosuppressants in the treatment of nonrenal systemic lupus erythematosus (SLE). METHODS We conducted a sensitive literature search in Medline, Embase, and the Cochrane Central Register of Controlled Trials up to October 2011. The selection criteria were studies including adult patients with SLE, a treatment intervention with nonbiologic immunosuppressants, a placebo or active comparator group, and outcome measures assessing efficacy and/or safety. Meta-analyses, systematic reviews, clinical trials, and cohort studies were included. The quality of each study was evaluated using Jadad’s scale and the Oxford Levels of Evidence. RESULTS In total, 158 of the 2,827 initially found articles were selected for detailed review; 65 studies fulfilled the predetermined criteria. Overall, the studies were low quality, with only 11 randomized controlled trials (RCTs). Cyclophosphamide demonstrated efficacy for neuropsychiatric SLE, preventing relapses with an additional steroid sparing effect, although its use was associated with cumulative damage, development of cervical intraepithelial neoplasia,and ovarian failure. Other immunosuppressants (azathioprine, methotrexate, leflunomide, mycophenolate mofetil,and cyclosporin A) demonstrated efficacy in reducing nonrenal activity and flares with a steroid-sparing effect, although only on occasion in non–placebo-controlled RCTs of small numbers of patients. CONCLUSION Several immunosuppressants demonstrated their safety and efficacy in nonrenal SLE. A specific drug for each particular manifestation cannot be recommended, although cyclophosphamide may be used in more severe cases, and methotrexate may be the first option in most cases of moderately active SLE. High-quality RCTs of larger numbers of patients are needed.
Collapse
|
20
|
Abstract
Pregnancy poses an important challenge for doctors looking after women with systemic lupus erythematosus. Knowledge about safety of medications, the effect of pregnancy on such disease, and vice versa, together with multidisciplinary team care, are basic cornerstones needed to provide the best obstetric and medical care to these women. Pre-conceptional counselling constitutes the ideal scenario where a patient's previous obstetric history, organ damage, disease activity, serological profile and additional medical history can be summarized. Important issues regarding medication adjustment, planned scans and visits, and main risks discussion should also be raised at this stage. Planned pregnancies lead to better outcomes for both mothers and babies. Close surveillance throughout pregnancy and the puerperium, and tailored management approach guarantee the highest rates of successful pregnancies in these women.
Collapse
Affiliation(s)
- O Ateka-Barrutia
- Lupus Research Unit, Women's Health Division, King's College London, UK
| | | |
Collapse
|
21
|
|
22
|
Hamed HO, Ahmed SR, Alzolibani A, Kamal MM, Mostafa MS, Gamal RM, Atallah DA, Abd-El-Aall DEM. Does cutaneous lupus erythematosus have more favorable pregnancy outcomes than systemic disease? A two-center study. Acta Obstet Gynecol Scand 2013; 92:934-42. [DOI: 10.1111/aogs.12158] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 04/18/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - Salah R. Ahmed
- Department of Obstetrics & Gynecology; Qassim University; Buraidah; Saudi Arabia
| | | | | | - Marwa S. Mostafa
- Department of Microbiology; Qassim University; Buraidah; Saudi Arabia
| | - Rania M. Gamal
- Department of Rheumatology; Assiut University; Assiut; Egypt
| | | | | |
Collapse
|
23
|
Ateka-Barrutia O, Nelson-Piercy C. Management of rheumatologic diseases in pregnancy. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/ijr.12.54] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
24
|
Abstract
Systemic lupus erythematosus (SLE) is an autoantibody-mediated systemic autoimmune disease, predominantly affecting young females. Pregnancy is increasingly common in the setting of SLE, as survival and quality of life of patients improve. Although live births can be achieved in the most cases, pregnancy in patients with SLE remains a high-risk condition. Maternal and fetal mortality and morbidity are considerably increased, compared with the general population. Aberrations in pregnancy-related maternal immune adaptations are likely contributors. Active maternal disease, renal involvement, specific autoantibody subsets and advanced organ damage are predictors of poor outcome. Therapeutic options are limited during pregnancy as maternal benefit has to be weighed against fetal risk. Prevention of preterm birth and refractory pregnancy loss, as well as management of established neonatal heart block remain unmet needs. Further research should address these important issues that affect young patients with SLE and their babies.
Collapse
|
25
|
Stanhope TJ, White WM, Moder KG, Smyth A, Garovic VD. Obstetric Nephrology: Lupus and Lupus Nephritis in Pregnancy. Clin J Am Soc Nephrol 2012; 7:2089-99. [DOI: 10.2215/cjn.12441211] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
26
|
Carp HJ, Selmi C, Shoenfeld Y. The autoimmune bases of infertility and pregnancy loss. J Autoimmun 2012; 38:J266-74. [PMID: 22284905 DOI: 10.1016/j.jaut.2011.11.016] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 11/28/2011] [Accepted: 11/28/2011] [Indexed: 11/26/2022]
|
27
|
Pregnancy implications for systemic lupus erythematosus and the antiphospholipid syndrome. J Autoimmun 2012; 38:J197-208. [DOI: 10.1016/j.jaut.2011.11.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 11/22/2011] [Indexed: 01/01/2023]
|