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Madanchi N, Fava A, Goldman DW, Magder LS, Petri M. Association Between 25-hydroxyvitamin D Levels and Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2024. [PMID: 39313480 DOI: 10.1002/acr.25440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/13/2024] [Accepted: 08/16/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE We evaluated the association of 25-hydroxyvitamin D (25(OH)D) levels with adverse pregnancy outcomes in systemic lupus erythematosus (SLE). METHODS The Hopkins Lupus Cohort includes visits of pregnant patients, including assessment of 25(OH)D levels at each visit. We examined the relationship between 25(OH)D levels and adverse pregnancy outcomes (miscarriage, preterm delivery, and small for gestational age). We also used a time-to-event analysis to assess whether time-varying of 25(OH)D levels were associated with time to miscarriage or preterm delivery. RESULTS In subgroups of patients defined by the average of 25(OH)D levels, we observed significantly different risks of miscarriage (P = 0.0045), preterm delivery (P = 0.0007), and the composite measure of all three adverse pregnancy outcomes (P = 0.011). The highest risks were observed among those with the lowest or highest levels of vitamin D. Nine of 10 pregnant patients with low vitamin D levels during the second trimester resulted in having a premature delivery. The time-to-event model confirmed the same U-shaped association after adjustment for SLE disease activity; however, the increased risk among those with highest levels of vitamin D was not statistically significant. Body mass index did not appear to be a confounding factor. CONCLUSION Our study is not able to prove causation, but the results strongly suggest an association of 25(OH)D at both lower and higher levels with adverse pregnancy outcomes. We recommend the monitoring of maternal serum 25(OH)D levels during SLE pregnancies, aiming for the ideal range of 40 to 59 ng/mL.
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Affiliation(s)
| | - Andrea Fava
- Johns Hopkins University, Baltimore, Maryland
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Akkuş F, Doğru Ş. Platelet ındices as potential biomarkers of perinatal outcomes in women with SLE during pregnancy. Arch Gynecol Obstet 2024; 310:825-832. [PMID: 38548951 DOI: 10.1007/s00404-024-07446-w] [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: 10/11/2023] [Accepted: 02/23/2024] [Indexed: 07/19/2024]
Abstract
AIM This study aimed to assess the platelet parameters and their prognostic value for perinatal outcomes in pregnant women with systemic lupus erythematosus (SLE). METHODS This retrospective study involved 180 participants, 90 pregnant women with SLE and 90 healthy pregnant women. Clinical and demographic variables including routine first-trimester neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet parameters such as platelet distribution width (PDW), mean platelet volume (MPV), plateletcrit (PCT) were compared between the groups. The perinatal outcomes of the whole study group were also compared. RESULTS SLE patients had lower leukocyte (p = 0.001), lymphocyte (p = 0.001) and platelet counts (p = 0.018), higher PDW (p = 0.002), MPV (p = 0.001), NLR (p = 0.008) and PLR (p = 0.015) and lower PCT (p = 0.015) than the control group. The groups had no significant difference in hemoglobin levels (p = 0.936). SLE patients had higher rates of cesarean section (p = 0.002), small for gestational age (SGA) (p = 0.019) and stillbirth (p = 0.017) and lower birth weight (p = 0.001) than the control group. PCT was a significant predictor of stillbirth with a cut-off value of 0.21, sensitivity of 64.3% and specificity of 83.3% (AUC: 0.843, p < 0.001). CONCLUSION Pregnant women with SLE have altered platelet parameters and increased inflammatory markers compared to healthy pregnant women. PCT is a simple and useful marker for predicting stillbirth risk in SLE pregnancies.
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Affiliation(s)
- Fatih Akkuş
- Department of Obstetrics and Gynecology, Division of Perinatology, Necmettin Erbakan University Medical School of Meram, Hocacihan Neighborhood, Abdulhamidhan Street, No: 3 Selçuklu, Konya, Turkey.
| | - Şükran Doğru
- Department of Obstetrics and Gynecology, Division of Perinatology, Necmettin Erbakan University Medical School of Meram, Hocacihan Neighborhood, Abdulhamidhan Street, No: 3 Selçuklu, Konya, Turkey
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Chen Y, Chen Y, Li B, Xu W, Lei P, Liu H, Liu D, Hong X. Construction and application of fetal loss risk model in systemic lupus erythematosus patients with mild disease severity. BMC Pregnancy Childbirth 2024; 24:497. [PMID: 39044159 PMCID: PMC11264457 DOI: 10.1186/s12884-024-06679-6] [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: 01/16/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND This dynamic nomogram model was developed to predict the probability of fetal loss in pregnant patients with systemic lupus erythematosus (SLE) with mild disease severity before conception. METHODS An analysis was conducted on 314 pregnancy records of patients with SLE who were hospitalized between January 2015 and January 2022 at Shenzhen People's Hospital, and the Longhua Branch of Shenzhen People's Hospital. Data from the Longhua Branch of the Shenzhen People's Hospital were utilized as an independent external validation cohort. The nomogram, a widely used statistical visualization tool to predict disease onset, progression, prognosis, and survival, was created after feature selection using multivariate logistic regression analysis. To evaluate the model prediction performance, we employed the receiver operating characteristic curve, calibration curve, and decision curve analysis. RESULTS Lupus nephritis, complement 3, immunoglobulin G, serum albumin, C-reactive protein, and hydroxychloroquine were all included in the nomogram model. The model demonstrated good calibration and discriminatory power, with an area under the curve of 0.867 (95% confidence interval: 0.787-0.947). According to decision curve analysis, the nomogram model exhibited clinical importance when the probability of fetal loss in patients with SLE ranged between 10 and 70%. The predictive ability of the model was demonstrated through external validation. CONCLUSION The predictive nomogram approach may facilitate precise management of pregnant patients with SLE with mild disease severity before conception.
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Affiliation(s)
- Yanran Chen
- The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Yanjuan Chen
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Bo Li
- Department of Rheumatology and Immunology, Shenzhen Longhua people's Hospital, Shenzhen, China
| | - Wengyi Xu
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Peipei Lei
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Hongyang Liu
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Dongzhou Liu
- The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China.
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.
| | - Xiaoping Hong
- The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China.
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.
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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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Zhou X, Cai F, Li S, Li G, Zhang C, Xie J, Yang Y. Machine learning techniques for prediction in pregnancy complicated by autoimmune rheumatic diseases: Applications and challenges. Int Immunopharmacol 2024; 134:112238. [PMID: 38735259 DOI: 10.1016/j.intimp.2024.112238] [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: 03/05/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/14/2024]
Abstract
Autoimmune rheumatic diseases are chronic conditions affecting multiple systems and often occurring in young women of childbearing age. The diseases and the physiological characteristics of pregnancy significantly impact maternal-fetal health and pregnancy outcomes. Currently, the integration of big data with healthcare has led to the increasing popularity of using machine learning (ML) to mine clinical data for studying pregnancy complications. In this review, we introduce the basics of ML and the recent advances and trends of ML in different prediction applications for common pregnancy complications by autoimmune rheumatic diseases. Finally, the challenges and future for enhancing the accuracy, reliability, and clinical applicability of ML in prediction have been discussed. This review will provide insights into the utilization of ML in identifying and assisting clinical decision-making for pregnancy complications, while also establishing a foundation for exploring comprehensive management strategies for pregnancy and enhancing maternal and child health.
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Affiliation(s)
- Xiaoshi Zhou
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Feifei Cai
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shiran Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guolin Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Changji Zhang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jingxian Xie
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; College of Pharmacy, Southwest Medical University, Luzhou, China
| | - Yong Yang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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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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Muñoz Muñoz C, Farinha F, McDonnell T, J'bari H, Nguyen H, Isenberg D, Rahman A, Williams D, Alijotas-Reig J, Giles I. Comparing pregnancy outcomes in patients with Systemic Lupus Erythematosus (SLE) and Undifferentiated Connective Tissue Disease (UCTD): a descriptive cohort study. Rev Clin Esp 2024; 224:357-365. [PMID: 38670225 DOI: 10.1016/j.rceng.2024.04.013] [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: 03/26/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Females diagnosed with systemic lupus erythematosus (SLE) face an elevated risk of adverse pregnancy outcomes (APOs). However, the evidence regarding whether a similar association exists in patients with undifferentiated connective tissue disease (UCTD) is inconclusive. METHODS We conducted a retrospective review (2006-2019) of pregnancy outcomes among patients with SLE (n = 51) and UCTD (n = 20) within our institution. We examined the occurrence of various APOs, encompassing miscarriage, stillbirth, termination, preterm birth, pre-eclampsia, eclampsia, HELLP syndrome, intrauterine growth restriction, abruption placentae, congenital heart block, or other cardiac abnormalities. RESULTS The mean age at pregnancy was 35 ± 7.0 years for patients with SLE and 35 ± 6.8 years for those with UCTD (p = 0.349). The proportion of Caucasian women was 47% in SLE and 80% in UCTD. Pregnancies in both groups were planned (81% in SLE and 77% in UCTD), and patients presented with inactive disease at conception (96% in SLE and 89% in UCTD). Hydroxychloroquine at conception was utilized by 86% of women with SLE, in contrast to 36% in the UCTD group. Both, SLE and UCTD cohorts exhibited low rates of disease flares during pregnancy and/or puerperium (14% vs. 10%). The incidence of APOs was 15.6% in SLE patients compared to 5% in those with UCTD (Risk difference 19.5%; 95% confidence interval: -3.9 to 43.1; p = 0.4237). CONCLUSION Our study underscores the importance of strategic pregnancy planning and the maintenance of appropriate treatment throughout pregnancy to ensure optimal disease management and minimize adverse outcomes in both SLE and UCTD pregnancies.
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Affiliation(s)
- Candido Muñoz Muñoz
- Centre for Rheumatology, Division of Medicine, University College London, London, UK; Systemic Autoimmune Disease Unit, Department of Medicine, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Filipa Farinha
- Centre for Rheumatology, Division of Medicine, University College London, London, UK; Rheumatology, Hospital Distrital de Santarém, Santarém, Portugal
| | - Thomas McDonnell
- Department of Biochemical Engineering, University College London, London, UK
| | - Hajar J'bari
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Hanh Nguyen
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Anisur Rahman
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - David Williams
- Women's Health, University College London Hospital NHS Foundation Trust, London, UK
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Medicine, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Ian Giles
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
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Zhu S, Ren J, Feng L, Jiang Y. Systemic Lupus Erythematosus and Pregnancy Complications and Outcomes: A Mendelian Randomization Study and Retrospective Validation. Int J Womens Health 2024; 16:891-902. [PMID: 38779383 PMCID: PMC11110830 DOI: 10.2147/ijwh.s461640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Previous studies have shown that pregnant women with systemic lupus erythematosus (SLE) tend to have a higher risk of adverse pregnancy outcomes, but the potential causal role remained unclear. In this study, we aimed to investigate the causal relationship between SLE and some common pregnancy complications and outcomes using two-sample Mendelian randomization (MR). Methods The genetic tools were derived from genome-wide association studies of SLE and pregnancy complications and outcomes. MR analysis was performed using inverse variance weighting as primary method. Sensitivity analyses were performed to evaluate the robustness of the results. A retrospective analysis was conducted on 200 pregnant women with SLE and a control group of pregnant women delivering at Tongji Hospital. Results In the results, we found that genetic susceptibility to SLE was associated with a higher risk of gestational diabetes mellitus (OR = 1.028, 95% CI: 1.006-1.050), premature delivery (OR = 1.039, 95% CI: 1.013-1.066), polyhydramnios (OR = 1.075, 95% CI: 1.004-1.151) and premature rupture of membranes (OR = 1.030, 95% CI: 1.001-1.060). Some of the retrospective analysis results align with the findings from the MR analysis, indicating that pregnant women with SLE have a higher risk of developing gestational diabetes mellitus and preterm birth. Additionally, although MR analysis did not reveal a causal relationship between SLE and preeclampsia/eclampsia, retrospective analysis discovered that SLE pregnant women are more susceptible to developing preeclampsia/eclampsia (OR = 2.935, 95% CI: 1.118-7.620). Conclusion Our study findings suggest a potential causal relationship between SLE and increased risks of gestational diabetes and preterm delivery. Clinical data indicate that pregnant women with SLE are more prone to developing preeclampsia/eclampsia. Clinicians need to be vigilant about the occurrence of these conditions when managing pregnant women with SLE.
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Affiliation(s)
- Shenglan Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Junlin Ren
- Department of Computer Science, Huazhong University of Science and Technology, Wuhan, 430074, People’s Republic of China
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Yi Jiang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
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Shao S, Zhang Y, Liu J, Zeng C, Qin J, Liu Z, Zhang X. Glucocorticoid use and varying doses on the long-term outcomes of offspring born to patients with systemic lupus erythematosus. Eur J Pediatr 2024; 183:2231-2238. [PMID: 38393371 DOI: 10.1007/s00431-024-05462-1] [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: 11/15/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
This study aims to assess the impact of non-fluorinated glucocorticoid use and varying doses on the long-term physical, neurological, and social-emotional development outcomes of offspring born to patients with systemic lupus erythematosus (SLE). The goal is to provide guidance on the appropriate dosage of glucocorticoids during pregnancy in SLE patients. We conducted a follow-up study on the offspring of SLE patients who had pregnancies and were admitted to our obstetrics department between January 1, 2016, and September 30, 2021. Patients who received immunosuppressants and dexamethasone were excluded from the study. The SLE patients were categorized into three groups based on their glucocorticoid use during pregnancy: hormone-free group, ≤ 10 mg/day group, and > 10 mg/day group (equivalent to prednisone). Most patients in the three groups were used hydroxychloroquine during pregnancy. We assessed the physical development status, including weight, height (length), and other relevant factors in three groups. Additionally, we utilized the Age and Stages Questionnaires, Third Edition (ASQ-3) to evaluate the development of communication, gross motor, fine motor, problem-solving, and personal-social. The social-emotional development status was assessed using the Age and Stages Questionnaires: Social-Emotional (ASQ: SE). We standardized the weight, height (length), body mass index, and ASQ-3 domain scores of children of different ages and genders into Z-scores for comparison. The results of this study demonstrated no statistically significant differences in the long-term physical development, neurological development, and social-emotional development outcomes of the offspring of SLE patients in three groups. However, while not reaching statistical significance, it was found that the offspring of the > 10 mg/day group had lower height (length) Z-scores and communication Z-scores compared to the other groups. Conclusion: The use of non-fluorinated glucocorticoids during pregnancy and varying doses did not have a significant impact on the long-term physical, neurological, and social-emotional development outcomes of offspring born to SLE patients. However, the offspring of SLE patients treated with glucocorticoids > 10 mg/day during pregnancy may be necessary to strengthen the monitoring of height (length) and communication skills in the long term. What is Known: • Fetal exposure to glucocorticoids can have implications for the development of multiple systems and may persist after birth, potentially increasing the risk of neurological abnormalities and other diseases. • There is limited research on the long-term development of offspring born to SLE patients, especially the patients treated with glucocorticoids. What is New: • The use of non-fluorinated glucocorticoids during pregnancy and varying doses did not have a significant impact on the long-term outcomes of offspring born to SLE patients. • The offspring of SLE patients treated with glucocorticoids >10 mg/day during pregnancy may be necessary to strengthen the monitoring of height (length) and communication skills in the long term.
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Affiliation(s)
- Shuming Shao
- Department of Pediatrics, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Yimin Zhang
- Department of Pediatrics, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Jie Liu
- Department of Pediatrics, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Chaomei Zeng
- Department of Pediatrics, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Zheng Liu
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38, Xueyuan Road, Beijing, 100191, China.
| | - Xiaorui Zhang
- Department of Pediatrics, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China.
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Barros T, Braga J, Abreu MI, Brandão M, Farinha F, Marinho A, Braga A. Sjögren's syndrome and pregnancy: a Portuguese case-control study. Reumatologia 2022; 60:311-317. [PMID: 36381208 PMCID: PMC9661414 DOI: 10.5114/reum.2022.120754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/03/2022] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Pregnancy in patients with autoimmune disorders is associated with an increased risk of adverse outcomes. Sjögren's syndrome (SS) is one of the most common among autoimmune diseases. Presently data regarding the impact of SS on obstetric outcomes are scarce and inconclusive. This study aims to evaluate the impact of SS on maternal-fetal and neonatal outcomes compared with pregnancy outcomes in the general population. MATERIAL AND METHODS A retrospective case-control study included 26 pregnancies in SS patients and a healthy control group (CG), followed in a Portuguese tertiary center, between 2015 and 2020. Baseline maternal data were collected, and maternal-fetal and neonatal outcomes were evaluated. Statistical analysis used SPSS 25.0, and a p-value of 0.05 was considered statistically significant. RESULTS All pregnancies occurred after the diagnosis of SS, with a mean exposure time between diagnosis and pregnancy of 4.92 ±2.78 years. In the SS group, the incidence of ANA, anti-Ro/SSA, and anti-La/SSB antibodies positivity was 80.8%, 61.5%, and 46.2%, respectively. Hydroxychloroquine (HCQ) was used in 57.7%.Miscarriage was significantly higher in the SS group (19.2% vs. 1.8%, p < 0.01). There was a higher prevalence of fetal growth restriction (OR 11.16, 95% CI: 0.96-129.26). Preterm delivery (9.5% vs. 5.6%, p = 0.503) and mean birth weight (2998.16 g vs. 3155.79 g, p = 0.178) did not differ significantly between the groups. In the SS group, admission to the neonatal intensive care unit (NICU) rate was increased (OR 71.67, 95% CI: 3.78-1357.16). Three pregnancies were complicated by congenital heart block (CHB) (14.3% vs. 0%, p = 0.015). In all cases, the diagnosis was performed during second trimester of pregnancy, and betamethasone was administered. CONCLUSIONS Women with SS had a significantly higher incidence of miscarriage, admission to NICU, and CHB than controls. Congenital heart block was the most critical condition that affects the offspring of mothers with SS. Successful pregnancy in the study group was possible with prenatal monitoring and a multidisciplinary approach.
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Affiliation(s)
- Tânia Barros
- Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Portugal
| | - Jorge Braga
- Maternal Fetal Unit, Centro Materno Infantil Do Norte, Centro Hospitalar Universitário do Porto, Portugal
| | - Maria Inês Abreu
- Instituto Ciências Biomédicas Abel Salazar, University of Porto, Portugal
| | - Mariana Brandão
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal
| | - Fátima Farinha
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal
| | - António Marinho
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal
| | - António Braga
- Maternal Fetal Unit, Centro Materno Infantil Do Norte, Centro Hospitalar Universitário do Porto, Portugal
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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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Braga A, Neves E, Guimarães J, Braga J, Vasconcelos C. The dynamics of Th17 / Treg ratio in SLE patients during pregnancy. J Reprod Immunol 2022; 151:103622. [DOI: 10.1016/j.jri.2022.103622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/22/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022]
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