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Saavedra MÁ, Gracia-Aréchiga TS, Miranda-Hernández D, Sánchez A, Arrucha-Cozaya M, Cruz-Domínguez MDP. Active but not quiescent lupus nephritis during pregnancy is associated with a higher rate of adverse obstetric outcomes: Analysis of a prospective cohort. Int J Gynaecol Obstet 2024. [PMID: 38736284 DOI: 10.1002/ijgo.15601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 04/08/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To compare the maternal-fetal/neonatal outcome in patients with systemic lupus erythematosus (SLE) with and without lupus nephritis (LN) in remission or with active disease. METHODS A prospective cohort of pregnant patients with SLE (ACR 1997 criteria) was studied from January 2009 to December 2021. Demographic, clinical, biochemical, and immunological variables as well as the usual maternal-fetal/neonatal complications were recorded. We compared four groups according to the status of SLE during pregnancy: patients with quiescent SLE without lupus nephritis, patients with active SLE without lupus nephritis, patients with quiescent lupus nephritis, and patients with active lupus nephritis. Statistical analysis included descriptive statistics, bivariate analysis, and Cox regression analysis. RESULTS A total of 439 pregnancies were studied, with a median age of 28 ± 6, SLE duration of 60 months (interquartile range 36-120). A higher frequency of maternal and fetal/neonatal complications was observed in patients with active SLE with or without lupus nephritis. Multivariate analysis showed that active LN was a risk factor for gestational hypertension (hazard ratios [HR] 1.95; 95% confidence intervals [CI]: 1.01-6.39), premature rupture of membranes (HR 3.56; 95% CI: 1.79-16.05) and more frequent cesarean section (HR 1.82; 95% CI: 1.13-2.94). CONCLUSION LN is associated with a higher frequency of maternal complications, especially in those patients with active disease during pregnancy, and those maternal complications had an impact on poor fetal/neonatal outcomes. Strict control and timely care of LN could improve the obstetric prognosis.
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Affiliation(s)
- Miguel Ángel Saavedra
- División de Investigación en Salud, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Tayde Sarahí Gracia-Aréchiga
- Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Dafhne Miranda-Hernández
- Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Antonio Sánchez
- Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - María Del Pilar Cruz-Domínguez
- Dirección de Educación e Investigación en Salud, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, México City, Mexico
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Medina G, González-Cortés FR, Sánchez-González A, Vázquez-Rodríguez JG, Ordoñez-González I, Jiménez-Arellano MP, García-Collinot G, Morales-Montalvo SI, Florez-Durante OI, Cruz-Domínguez MP, Colorado-Cruz MF, Zurita-Muñoz MA, Cruz-Arteaga G, Sánchez-Enriquez C, Jara LJ, Saavedra MÁ. The prognostic value of neutrophile/lymphocyte ratio and serum chemerin to predict maternal-fetal complications in pregnant systemic lupus erythematosus patients. Lupus 2023; 32:1409-1417. [PMID: 37840528 DOI: 10.1177/09612033231206446] [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] [Indexed: 10/17/2023]
Abstract
BACKGROUND Pregnancy in SLE continues to be a challenge. The neutrophil-to-lymphocyte ratio (NLR) and chemerin are predictors of preeclampsia in the general population; however, their role as predictors of maternal-fetal complications in pregnant SLE patients has not been analyzed. OBJECTIVE To investigate the prognostic value of NLR and serum chemerin, to predict maternal-fetal complications in pregnant SLE patients, and compare both biomarkers among three study groups. METHODS Design: Analytical cross-sectional study of cases and controls with the following study groups: systemic lupus erythematosus (SLE), preeclampsia, and healthy. NLR and chemerin serum were determined between 20 and 25 weeks of gestation. Patients were evaluated every 4-6 weeks until pregnancy resolution. Maternal and fetal outcomes were registered. We employed Receiver Operating Characteristic (ROC) curves to validate prognostic values. RESULTS Seventy pregnant patients were included: 20 with SLE, 20 with preeclampsia, and 30 healthy pregnant women; NLR values were 4 (2.3-5.6) in SLE, 6 (4.6-9.2) in preeclampsia, and 2.8 (2.1-2.9) in the group of healthy women (p = .0001). Chemerin levels were: 26 (15.3-56.2) in SLE, 96 (37.3-146.2) in preeclampsia, and 24.6 ng/mL (15.3-47.4) in the healthy group (p = .007) Maternal complications were observed in 11 (55%), 20 (100%), and 8 (26%) per group, respectively. Thrombocytopenia was the most frequent complication in all pregnant women, followed by hypertensive disorders. Fetal complications were registered in 12 (60%), 16 (80%), and 2 (6.7%), respectively. Congenital malformations and prematurity were the most frequent fetal complications. NLR had good diagnostic accuracy in predicting maternal-fetal complications (AUROC 0.715) p = .015, CI 95% 0.56-0.86, cut-off point level: 2.9, sensitivity 61%, specificity 78%, positive predictive value (PPV) 65%, negative predictive value (NPV) 75%. Regarding chemerin, a cut-off point level >43 ng/mL had a sensitivity of 75%, specificity of 72% AUROC 0.75, p = .001, CI 95% 0.61-0.89, PPV 51.7% NPV 87.8%, meaning that 51.7% of patients with chemerin levels >43 ng/mL have or will have preeclampsia. CONCLUSION The NLR may help predict maternal-fetal complications in SLE pregnancy, constituting a marker of subclinical inflammation. Chemerin levels may be associated with preeclampsia. These biomarkers could improve the care of SLE patients with timely intervention of potential complications during pregnancy.
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Affiliation(s)
- Gabriela Medina
- Translational Research Unit, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Antonio Sánchez-González
- Rheumatology Department, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juan G Vázquez-Rodríguez
- Intensive Care Unit, Hospital de Gineco-Obstetricia No. 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - María P Jiménez-Arellano
- Hospital de Gineco-Obstetricia No. 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Grettel García-Collinot
- Hospital de Gineco-Obstetricia No. 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Oscar I Florez-Durante
- Translational Research Unit, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - María P Cruz-Domínguez
- Universidad Nacional Autónoma de México, Mexico City, Mexico
- Direction of Education and Research, Hospital de Especialidades Centro Médico Nacional La Raza "Dr Antonio Fraga Mouret," Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Miguel A Zurita-Muñoz
- Unidad de Medicina Familiar No. 20, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Gilberto Cruz-Arteaga
- Unidad de Medicina Familiar No. 20, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Luis J Jara
- Division of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Miguel Á Saavedra
- Research Division, Instituto Mexicano del Seguro Social, Hospital de Especialidades Centro Médico Nacional La Raza, Mexico City, Mexico
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Khogali HI, Al-Bluwi GSM, Guy Pedo V, Al Dhanhani AM. Maternal and fetal health outcomes in systemic lupus erythematosus pregnancies in the Emirati population: A comparative study. Lupus 2023; 32:1453-1461. [PMID: 37786253 DOI: 10.1177/09612033231204650] [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] [Indexed: 10/04/2023]
Abstract
OBJECTIVES To evaluate adverse pregnancy outcomes in patients with systemic lupus erythematosus (SLE), compare their maternal and fetal outcomes with those of age-matched pregnant women without SLE, and identify factors linked to increased risks of adverse outcomes. METHODS Medical records from Tawam Hospital were reviewed retrospectively to identify patients with SLE and a history of pregnancy. Demographics, clinical variables, and maternal and fetal outcomes were obtained. A one-to-one age-matched healthy control group was randomly selected. The outcomes and odd ratios of women with and without SLE were compared, and factors associated with adverse pregnancy outcomes were examined. RESULTS The outcomes of 78 SLE pregnancies in 39 women were analyzed. Adverse maternal outcomes, such as gestational diabetes mellitus (GDM), occurred in 32% of pregnancies, whereas adverse fetal outcomes, such as low-birth weight and preterm deliveries, occurred in 51% of pregnancies. Pregnant women with SLE had a 5-fold higher risk of GDM, had higher odds of maternal hypertension, and were more likely to deliver through cesarean section than those without SLE. Preterm deliveries and low-birth weight were also more common in SLE pregnancies. Steroid use during pregnancy was significantly associated with an increased risk of GDM development. Lupus nephritis, maternal hypertension, pre-eclampsia, and GDM were linked to preterm deliveries. CONCLUSION Pregnant women with SLE were at a higher risk for adverse maternal and fetal outcomes than age-matched pregnant women without SLE. These findings can guide clinical management and emphasize the need for close monitoring of SLE pregnancies.
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Affiliation(s)
| | - Ghada S M Al-Bluwi
- Internal Medicine Department, College of Medicine & Health Sciences, UAE University, Al Ain, UAE
| | - Virgie Guy Pedo
- Internal Medicine Department, College of Medicine & Health Sciences, UAE University, Al Ain, UAE
| | - Ali M Al Dhanhani
- Internal Medicine Department, College of Medicine & Health Sciences, UAE University, Al Ain, UAE
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Li ZJ, Hu HY, Ding ZL, Bian ZW, Xu YH, Wen HT, Qu YL, Wang JD, Huang XL, Li D, Li J, Hu GF. Characteristics of childhood-onset systemic lupus erythematosus in pregnancy and its association with pregnancy outcomes: a retrospective comparative cohort study. Reprod Biol Endocrinol 2022; 20:78. [PMID: 35590424 PMCID: PMC9118857 DOI: 10.1186/s12958-022-00954-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disease situations are more aggressive in patients with childhood-onset systemic lupus erythematosus (cSLE) than in those with adult-onset SLE (aSLE). However, information on pregnant women with cSLE and its association with pregnancy outcomes is limited. This study aimed to compare pregnancies in patients with cSLE vs. aSLE, and further analyse the characteristics of cSLE in pregnant women and explore its association with adverse pregnancy outcomes. METHODS Altogether, data of 167 pregnancies from 150 women, including 22 pregnancies with cSLE and 145 pregnancies with aSLE, were retrospectively analysed. Characteristics and disease activity were compared between the cSLE and aSLE groups during pregnancy. Associations between cSLE and the risk of active SLE (SLEPDAI > 4), active lupus nephritis (LN), and adverse pregnancy outcomes were analysed using logistic regression. RESULTS The cSLE group had a higher incidence of active SLE (12/22 vs. 30/145, P = 0.001) and active LN (11/22 vs. 26/145, P = 0.001) than the aSLE group. In the multivariable analysis, cSLE was a risk factor for active SLE and active LN during pregnancy, with ORs of 4.742 (95%CI 1.678-13.405, P = 0.003) and 4.652 (95%CI 1.630-13.279, P = 0.004), respectively. No significant association between cSLE and the risk of composite adverse gestational outcomes was identified after sequentially adjusting pre-pregnancy characteristics and pregnancy factors (P > 0.05). CONCLUSION Disease activity of women with cSLE in pregnancy was more aggressive than that of women with aSLE, which was similar to the characteristics of non-pregnant women with SLE. cSLE might have indirect effects on the risk of adverse pregnancy outcomes through LN and active disease. Therefore, closely monitoring patients with cSLE during pregnancy is crucial.
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Affiliation(s)
- Zhi-Ju Li
- Department of Epidemiology, School of Public Health, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Hao-Yue Hu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, China
| | - Zi-Ling Ding
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, China
| | - Zi-Wei Bian
- Department of Epidemiology, School of Public Health, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Ying-Hua Xu
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Hui-Ting Wen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, China
| | - Ya-Li Qu
- Department of Epidemiology, School of Public Health, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Jin-Dong Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Xiao-Li Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Dong Li
- Department of Epidemiology, School of Public Health, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Jing Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, China.
| | - Gui-Fang Hu
- Department of Epidemiology, School of Public Health, Southern Medical University, No.1846, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
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Ying XH, Bao DN, Jiang HY, Shi YD. Maternal non-steroidal anti-inflammatory drug exposure during pregnancy and risk of miscarriage: a systematic review and meta-analysis. Eur J Clin Pharmacol 2021; 78:171-180. [PMID: 34635936 DOI: 10.1007/s00228-021-03222-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Numerous studies have suggested that non-steroidal anti-inflammatory drugs (NSAIDs) might be associated with increased risk of miscarriage. However, these results are conflicting and inconclusive. METHODS We performed this systematic review and meta-analysis to assess the relationship between NSAIDs exposure and risk of miscarriage. A systematic literature search was conducted to identify relevant studies published from the time of database inception until June 2021. RESULTS A total of ten studies involving 207,341 pregnant women were subjected to meta-analysis. There was no statistically significantly increased risk of miscarriage with the use of NSAIDs during pregnancy (OR = 1.37, 95% CI 0.99-1.88, p = 0.057). However, our findings showed that women exposed to NSAIDs around the time of conception were at increased risk of miscarriage (OR 2.32, 95% CI 1.16-4.66, p = 0.018). Furthermore, no significant association between NSAID use and miscarriage was evident during the first trimester of pregnancy (OR = 1, 95% CI = 0.83-1.2, p = 0.996), possibly attributable to the small sample size. CONCLUSION Our findings indicate that NSAID exposure around the time of conception might be a risk factor for miscarriage. Further studies are needed to evaluate whether the risk varies by the type, dosage, or timing of NSAID exposure.
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Affiliation(s)
- Xian-Hua Ying
- Department of Gynaecology and Obstetrics, Taizhou First People's Hospital, Taizhou, 318020, Zhejiang, China
| | - Dan-Ni Bao
- Department of Clinical Laboratory, Sanmen People's Hospital, Taizhou, Zhejiang, China
| | - Hai-Yin Jiang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, School of Medicine, the First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Yu-Dan Shi
- Department of Chinese Internal Medicine, Taizhou First People's Hospital, Taizhou, 318020, Zhejiang, China.
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