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Tanwir T, Raza A, Riaz M, Malik A, Ilyas S. Feto-maternal outcomes of pregnancies in women with SLE: Experience from a tertiary care center of Asia. Lupus 2023:9612033231184675. [PMID: 37328160 DOI: 10.1177/09612033231184675] [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: 06/18/2023]
Abstract
OBJECTIVE We aim to quantify the risk of maternal and fetal complications in patients with SLE in order to identify the impact of SLE on pregnancy and of pregnancy on SLE. METHODS This retrospective record review study was conducted in Aga khan university hospital, Karachi, from Jan 1998 to Dec 2019. All pregnant patients with SLE diagnosed and delivered during this time were included in the study. Categorical variables were analyzed by using chi-square test and fisher exact test. Whereas quantitative point estimate was estimated as mean and SD. We matched the data and computed crude odds ratio of pre-eclamptic patients with respect to age of conception, gravida, and body mass index in both case and control group. RESULTS The SLE disease activity was monitored during pregnancy under SLEDAI-2K Scoring system. The patients with mild (25.6%) and moderate (25.6%) disease activity were prevalent and most antenatal patients (51.7%) had flare up in third trimester. Adverse maternal outcomes include pre-eclampsia (28.8%), eclampsia (3.2%), cesarean section (57.6%), and thrombocytopenia (9.6%), whereas perinatal outcomes includes intrauterine growth retardation (24%), preterm birth <34 weeks (19.2%) and <37 weeks (63.2%), APGAR Score < 7 at 1 min (5.6%), and neonatal death (5.6%) found to be statistically significant in between two groups There were more high-risk patients (42) with positive IgG (88%), IgM (83.3%), and lupus anticoagulant (33.3%) as compared to low-risk APS group. CONCLUSION Planned pregnancy and less severe disease flares during pregnancy is associated with more favorable feto-maternal outcomes.
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Affiliation(s)
- Tabeer Tanwir
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Amir Raza
- Department of Obstetric and Gynecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Mehmood Riaz
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Ayesha Malik
- Department of Obstetric and Gynecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Shehla Ilyas
- Department of Obstetric and Gynecology, Aga Khan University Hospital, Karachi, Pakistan
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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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Braga A, Barros T, Faria R, Marinho A, Carvalheira G, Rocha G, Farinha F, Neves E, Vasconcelos C, Braga J. Systemic lupus erythematosus and pregnancy: A retrospective single-center study of 215 pregnancies from Portugal. Lupus 2021; 30:2165-2175. [PMID: 34693803 DOI: 10.1177/09612033211050340] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a life-threatening disorder that affects women at reproductive age. We evaluate the clinical impact of pregnancy in a cohort of Portuguese SLE patients and the risk factors associated with maternal and fetal adverse outcomes. METHODS A retrospective observational study that included all pregnant women with SLE managed at a Portuguese tertiary hospital, between January 1993 and December 2019. Baseline maternal information was collected, and maternal-fetal and neonatal outcomes were evaluated. Disease activity before and during pregnancy was assessed. RESULTS We included 215 pregnancies from 143 patients. Lupus nephritis was present in 20.0% and antiphospholipid syndrome (APS) in 21.9% of the cases. Preconception consultation was performed in 86.9% of the pregnancies, and 92.5% of the patients had no or low disease activity at conception. During gestation, 79.6% of the patients were under treatment, and hydroxychloroquine (HCQ) was the most commonly used drug (63.7%). Low-dose acetylsalicylic acid (ASA) was prescribed at conception in 87.9% of the patients. The live birth rate was 84.2%. An adverse pregnancy outcome (APO) occurred in 41.4% of the pregnancies. A miscarriage rate of 15.3% and a preterm delivery rate of 15.4% were found. Preeclampsia and fetal growth restriction complicated 13.1% and 14.0% of the gestations, respectively. Neonatal lupus occurred in 7.1% of the newborns, and there were 2 cases of congenital heart block. Significant risk factors for the development of AOP were disease activity at conception, lupus flare, hypocomplementemia, positivity for lupus anticoagulant, and APS. The use of ASA was significantly associated with a reduced incidence of miscarriage. An SLE flare was diagnosed in 16.3% of the cases. We identified as risk factors for lupus flares the presence of active disease at conception, a previous history of lupus nephritis, and the use of chronic medication. HCQ use during pregnancy was associated with a significant reduction of flare incidence during pregnancy and postpartum. CONCLUSIONS Pregnancy in an SLE patient is associated with an increased incidence of adverse obstetric outcomes. Good disease control before pregnancy and adequate treatment, especially with HCQ, is crucial to achieving the best obstetric results.
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Affiliation(s)
- António Braga
- Maternal Fetal Unit, 522166Centro Hospitalar Universitário do Porto, Centro Materno Infantil do Norte, Oporto, Portugal.,Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal
| | - Tânia Barros
- Maternal Fetal Unit, 522166Centro Hospitalar Universitário do Porto, Centro Materno Infantil do Norte, Oporto, Portugal
| | - Raquel Faria
- Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal.,Clinical Immunology Unit, 112085Centro Hospitalar Universitário do Porto, Oporto, Portugal
| | - António Marinho
- Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal.,Clinical Immunology Unit, 112085Centro Hospitalar Universitário do Porto, Oporto, Portugal
| | - Graziela Carvalheira
- Clinical Immunology Unit, 112085Centro Hospitalar Universitário do Porto, Oporto, Portugal
| | - Guilherme Rocha
- Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal.,Clinical Immunology Unit, 112085Centro Hospitalar Universitário do Porto, Oporto, Portugal.,Nephrology Department, 112085Centro Hospitalar Universitário do Porto, Oporto, Portugal
| | - Fátima Farinha
- Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal.,Clinical Immunology Unit, 112085Centro Hospitalar Universitário do Porto, Oporto, Portugal
| | - Esmeralda Neves
- Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal.,Clinical Immunology Unit, 112085Centro Hospitalar Universitário do Porto, Oporto, Portugal
| | - Carlos Vasconcelos
- Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal.,Clinical Immunology Unit, 112085Centro Hospitalar Universitário do Porto, Oporto, Portugal
| | - Jorge Braga
- Maternal Fetal Unit, 522166Centro Hospitalar Universitário do Porto, Centro Materno Infantil do Norte, Oporto, Portugal.,Instituto Ciências Biomédicas Abel Salazar, Oporto University, Oporto, Portugal.,Clinical Immunology Unit, 112085Centro Hospitalar Universitário do Porto, Oporto, Portugal
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4
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Braga A, Barros T, Faria R, Marinho A, Rocha G, Farinha F, Neves E, Vasconcelos C, Braga J. Systemic Lupus Erythematosus and Pregnancy: a Portuguese Case-Control Study. Clin Rev Allergy Immunol 2021; 62:324-332. [PMID: 34519994 DOI: 10.1007/s12016-021-08893-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/29/2022]
Abstract
Pregnancy in systemic lupus erythematosus (SLE) patients is associated with an increased risk of adverse outcomes. During pregnancy, SLE patients have a higher rate of miscarriage, stillbirth, preterm delivery, fetal growth restriction, or hypertensive disorders of pregnancy. To date, only a few case-control studies were published with the purpose to evaluate the magnitude of risk associated with pregnancy in lupus patients. The aim of our study was to evaluate the maternal and fetal outcomes in a cohort of Portuguese SLE patients and to compare it with a group of healthy pregnant women. We conducted a retrospective case-control study that included all pregnant women with SLE managed at a Portuguese tertiary center, between 2010 and 2019. Pregnancy outcomes were compared between SLE patients and a group of matched healthy pregnant women. Baseline maternal data was collected, and maternal-fetal and neonatal outcomes were evaluated. One hundred twenty-four SLE pregnancies were included. Of the patients, 95.2% were in remission at conception. In 13.7% of cases, a lupus flare was diagnosed during gestation and in 17.9% in the postpartum period. The live birth rate was 84.6%, and the incidence of adverse outcomes was 40.3% (OR 2.64, 95% CI 1.67-4.18). Considering only patients in remission at conception, the presence of adverse outcomes remained significantly higher (36.8% vs. 20.3%, P < 0.01). Miscarriage rate was 15.3% (OR 5.85, 95% CI 2.57-13.34) and preterm delivery occurred in 12.4% of the patients (OR 1.72, 95% CI 0.83-3.57). Preeclampsia prevalence was higher in SLE patients (OR 3.92, 95% CI 1.32-11.57). In the SLE group, the newborn admission to an intensive care unit rate was increased (OR 4.99, 95% CI 1.47-16.90). No neonatal or maternal deaths were reported. In our study, pregnancy with SLE was associated with an increased incidence of adverse outcomes, even in a population of SLE patients with well-controlled disease.
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Affiliation(s)
- António Braga
- Maternal Fetal Unit, Centro Materno Infantil Do Norte, Centro Hospitalar Universitário Do Porto, Oporto, Portugal. .,Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal.
| | - Tânia Barros
- Maternal Fetal Unit, Centro Materno Infantil Do Norte, Centro Hospitalar Universitário Do Porto, Oporto, Portugal
| | - Raquel Faria
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal.,Clinical Immunology Unit, Centro Hospitalar Universitário Do Porto, Oporto, Portugal
| | - António Marinho
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal.,Clinical Immunology Unit, Centro Hospitalar Universitário Do Porto, Oporto, Portugal
| | - Guilherme Rocha
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal.,Clinical Immunology Unit, Centro Hospitalar Universitário Do Porto, Oporto, Portugal.,Nephrology Department, Centro Hospitalar Universitário Do Porto, Oporto, Portugal
| | - Fátima Farinha
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal.,Clinical Immunology Unit, Centro Hospitalar Universitário Do Porto, Oporto, Portugal
| | - Esmeralda Neves
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal.,Clinical Immunology Unit, Centro Hospitalar Universitário Do Porto, Oporto, Portugal
| | - Carlos Vasconcelos
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal.,Clinical Immunology Unit, Centro Hospitalar Universitário Do Porto, Oporto, Portugal
| | - Jorge Braga
- Maternal Fetal Unit, Centro Materno Infantil Do Norte, Centro Hospitalar Universitário Do Porto, Oporto, Portugal.,Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal.,Clinical Immunology Unit, Centro Hospitalar Universitário Do Porto, Oporto, Portugal
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Miranda-Hernández D, Sánchez A, Sánchez-Briones RE, Rivas-Ruiz R, Cruz-Reynoso L, Cruz-Domínguez P, Jara LJ, Saavedra MÁ. Impact of Systemic Lupus Erythematosus on Pregnancy: Analysis of a Large 10-Year Longitudinal Mexican Cohort. J Clin Rheumatol 2021; 27:S217-S223. [PMID: 33264243 DOI: 10.1097/rhu.0000000000001626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pregnancy in patients with systemic lupus erythematosus is considered a high risk one since it is associated with a higher rate of maternal-fetal complications compared with the pregnancies in healthy women. OBJECTIVES The aim of this study was to describe the maternal-fetal outcomes in a cohort of Mexican patients with systemic lupus erythematosus and to identify risk factors associated with adverse maternal and fetal outcomes. PATIENTS AND METHODS A cohort of pregnant lupus patients was analyzed. Maternal-fetal complications were described, and clinical, biochemical, and immunological variables associated with obstetric adverse outcomes were studied. Descriptive statistics, comparison of variables using appropriate tests, and finally logistic regression analysis were performed to identify potential risk factors for adverse maternal and fetal outcomes. RESULTS A total of 351 pregnancies were included in a 10-year period. The most frequently observed maternal adverse outcomes were lupus flare (35%) and preeclampsia (14.5%). Active lupus before pregnancy (hazards ratio [HR], 3.7; 95% confidence interval [CI], 1.1-12.5; p = 0.003) was a predictor for these complications, whereas the use of antimalarial drugs (HR, 0.4; 95% CI, 0.2-0.7; p = 0.007) was a protective factor. The most frequent fetal adverse outcomes were preterm birth (38.1%), miscarriages (10%), and low birth weight babies (28%), and very low birth weight newborns (11%). Proteinuria in early pregnancy (HR, 7.1; 95% CI, 1.01-50.3; p = 0.04) and preeclampsia (HR, 9.3; 95% CI, 1.7-49.7; p = 0.009) were risk factors associated with these complications. CONCLUSIONS Variables related to systemic lupus erythematosus activity predict an adverse maternal outcome, whereas proteinuria in early pregnancy and preeclampsia are associated with an adverse fetal outcome.
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Affiliation(s)
- Dafhne Miranda-Hernández
- From the Rheumatology Unit, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza
| | - Antonio Sánchez
- From the Rheumatology Unit, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza
| | - Reyna E Sánchez-Briones
- From the Rheumatology Unit, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza
| | | | | | | | - Luis Javier Jara
- Direction of Education and Health Research, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Miguel Ángel Saavedra
- From the Rheumatology Unit, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza
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Louthrenoo W, Trongkamolthum T, Kasitanon N, Wongthanee A. Predicting factors of adverse pregnancy outcomes in Thai patients with systemic lupus erythematosus: A STROBE-compliant study. Medicine (Baltimore) 2021; 100:e24553. [PMID: 33592909 PMCID: PMC7870266 DOI: 10.1097/md.0000000000024553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
Studies on predicting factors for adverse pregnancy outcomes (APOs) in Thai patients with systemic lupus erythematosus (SLE) are limited. This retrospective observation study determined APOs and their predictors in Thai patients with SLE.Medical records of pregnant SLE patients in a lupus cohort, seen from January 1993 to June 2017, were reviewed.Ninety pregnancies (1 twin pregnancy) from 77 patients were identified. The mean age at conception was 26.94 ± 4.80 years. At conception, 33 patients (36.67%) had active disease, 23 (25.56%) hypertension, 20 (22.22%) renal involvement, and 6 of 43 (13.95%) positive anti-cardiolipin antibodies or lupus anti-coagulants, and 37 (41.11%) received hydroxychloroquine. Nineteen patients (21.11%) had pregnancy loss. Of 71 successful pregnancies, 28 (31.11%) infants were full-term, 42 (46.67%) pre-term and 1 (11.11%) post-term; 19 (26.39%) were small for gestational age (SGA), and 38 (52.58%) had low birth weight (LBW). Maternal complications occurred in 21 (23.33%) pregnancies [10 (11.11%) premature rupture of membrane (PROM), 8 (8.89%) pregnancy induced hypertension (PIH), 4 (4.44%) oligohydramnios, 2 (2.22%) post-partum hemorrhage, and 1 (1.11%) eclampsia]. Patients aged ≥ 25 years at pregnancy and those ever having renal involvement had predicted pregnancy loss with adjusted odds ratio (AOR) [95% CI] of 4.15 [1.10-15.72], P = .036 and 9.21 [1.03-82.51], P = .047, respectively. Renal involvement predicted prematurity (6.02 [1.77-20.52, P = .004), SGA (4.46 [1.44-13.78], P = .009), and LBW in infants (10.01 [3.07-32.62], P < .001). Prednisolone (>10 mg/day) and immunosuppressive drugs used at conception protected against prematurity (0.11 [0.02-0.85], P = .034). Flares and hematologic involvement predicted PROM (8.45 [1.58-45.30], P = .013) and PIH (9.24 [1.70-50.24], P = .010), respectively. Cutaneous vasculitis (33.87 [1.05-1,094.65], P = .047), and renal (31.89 [6.66-152.69], P < .001), mucocutaneous (9.17 [1.83-45.90], P = .007) and hematologic involvement (128.00 [4.60-3,564.46], P = .004) during pregnancy predicted flare; while prednisolone (>10 mg/day) and immunosuppressive drug use at conception reduced that risk (0.08 [0.01-0.68, P = .021).APOs remain a problem in Thai pregnant SLE patients. Renal involvement and SLE flares were associated with the risk of APOs.
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Affiliation(s)
- Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai
| | - Thananant Trongkamolthum
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai
- Allergy and Rheumatology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla
| | - Nuntana Kasitanon
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai
| | - Antika Wongthanee
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Scott RE, Greenwood SL, Hayes DJL, Baker BC, Jones RL, Heazell AEP. Effects of hydroxychloroquine on the human placenta-Findings from in vitro experimental data and a systematic review. Reprod Toxicol 2019; 87:50-59. [PMID: 31082466 DOI: 10.1016/j.reprotox.2019.05.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/15/2019] [Accepted: 05/09/2019] [Indexed: 12/12/2022]
Abstract
Hydroxychloroquine (HCQ), a toll like receptor (TLR) 7 and 9 antagonist, is used during pregnancy for inflammatory conditions with limited understanding of its placental toxicology. We hypothesized that HCQ does not have toxic effects on the placenta and can modulate cytokine release in response to TLR7/9 activation. A systematic review was conducted and no studies of HCQ on multicellular human placental tissue were identified. Accordingly, placental villous explants were cultured for 7 days with HCQ +/- TLR7/9 agonists. HCQ did not affect cell turnover, nutrient transport or cytokine release but increased IL-10 (anti-inflammatory) secretion and promoted syncytiotrophoblast regeneration. Cytokine release stimulated by TLR7/9 agonists was unaffected by HCQ. In conclusion, HCQ did not adversely affect placental tissue and may have a protective anti-inflammatory function. Further research is needed to determine the mechanisms of HCQ actions on human placenta and whether they could be utilized to improve pregnancy outcomes.
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Affiliation(s)
- Rebecca E Scott
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom. beckyscott-@hotmail.co.uk
| | - Susan L Greenwood
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Dexter J L Hayes
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Bernadette C Baker
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Rebecca L Jones
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
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Bundhun PK, Soogund MZS, Huang F. Arterial/venous thrombosis, fetal loss and stillbirth in pregnant women with systemic lupus erythematosus versus primary and secondary antiphospholipid syndrome: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2018; 18:212. [PMID: 29879927 PMCID: PMC5992885 DOI: 10.1186/s12884-018-1850-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/25/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND We aimed to systematically compare arterial/venous thrombosis, fetal loss and stillbirth in pregnant women with systemic lupus erythematosus (SLE), primary anti-phospholipid syndrome (PAPS) and secondary anti-phospholipid syndrome (SAPS). METHODS Online databases were carefully searched for relevant publications comparing SLE with PAPS and/or SAPS in pregnancy. Studies were included if: they compared SLE with APS [SLE versus PAPS or SLE versus SAPS or SLE versus PAPS and SAPS respectively] in pregnant women; and they reported specific adverse outcomes as their clinical endpoints including arterial/venous thrombosis, fetal loss and stillbirth. Risk ratios (RR) with 95% confidence intervals (CIs) were used as statistical parameters and the analysis was carried out by the RevMan 5.3 software. RESULTS A total number of 941 pregnant women were included: 556 were candidates of SLE; 200 were candidates of PAPS; and 185 were candidates of SAPS. APS was associated with a significantly higher risk of fetal loss (RR: 4.49, 95% CI: 2.09-9.64; P = 0.0001). In addition, stillbirth and arterial/venous thrombosis were also significantly increased with APS (RR: 6.65, 95% CI: 2.14-20.60; P = 0.001) and (RR: 3.95, 95% CI: 1.28-12.16; P = 0.02) respectively. When patients with PAPS were compared with patients who suffered from SLE alone, fetal loss and arterial/venous thrombosis were still significantly higher with the former. When SAPS were compared with SLE (without anti-phospholipid antibodies), arterial/venous thrombosis, stillbirth and fetal loss were still significantly higher with SAPS. However, no significant difference was observed in arterial/venous thrombosis and fetal loss between PAPS and SAPS. CONCLUSIONS PAPS and SAPS were associated with significantly higher arterial/venous thrombosis, fetal loss and stillbirth in comparison to SLE. However, no significant difference was observed when PAPS was compared to SAPS.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Department of Internal Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China
| | | | - Feng Huang
- Institute of Cardiovascular Diseases and Guangxi Key Laboratory Base of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China
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