| Objective: Systemic lupus erythematosus(SLE)is a systemic autoimmune disease that tends to occur in women of childbearing age.By comparing and analyzing the differences of disease activity during pregnancy and fetal outcome after delivery between SLE patients of planned and unplanned pregnancy,the appropriate pregnancy timing,disease activity evaluation and fetal evaluation strategies for SLE patients of childbearing age are proposed.To prevent and control the deter ioration of disease activity and adverse maternal-fetal outcomes after SLE pregnancy.Methods: Clinical data of 102 patients with systemic lupus erythematosus complicated with pregnancy admitted to Hospital,from September 2016 to July 2022 were retrospect ively analyzed.All patients met the criteria for classifying systemic lupus erythematosus revised by the American College of Rheumatology in 1997.Patients were divided into planned pregnancy group(n=72)and unplanned pregnancy group(n=30)according to the disease status before pregnancy.By comparing the general conditions of the two groups of patients,clinical manifestations during pregnancy,laboratory test results,gestational age of newborns,fetal weight,maternal complications during pregnancy a nd pregnancy outcome,statistical analysis was carried out.SLE disease activity was assessed by SLEDAI-2k,classified as mild 2k-6,moderate 2k-7-12 minutes SLEDAI-2k,and severe2 k >12 minutes SLEDAI-2k.According to Chinese recommendations on perinatal management of SLE women,planned pregnancy is defined as a patient with lupus who is allowed to become pregnant under the following conditions:(1)stable disease activity for at least 6 months;(2)Oral prednisone dose ≤ 15mg/d);(3)Urinary protein < 0.5g/24h;(4)no vital organ dysfunction;(5)Discontinue immunosuppressants with teratogenic effects on the fetus,including cyclophosphamide,methotrexate,and motecophenolate for at least 6 months;(6)Leflunomide should be discontinued for more than 6months,and eluting treatment should be performed for patients who used leflunomide before pregnancy.The unplanned pregnancy group included patients with disease activity before pregnancy or disease remission less than6 months,who had used immunosuppres sive drugs within 6 months before pregnancy,and who had not been evaluated by doctors and conceived by themselves,including patients with SLE at the beginning of pregnancy.Result: 1.The mean duration of SLE in the non-planned pregnancy group was 3.13±3.32 years,which was significantly shorter than 6.85±4.47 years in the planned pregnancy group,and the difference was statistically significant(P < 0.01).Compared to the unplanned pregnancy group and the planned pregnancy group,Gestational SLE disease activity rate(100.0% vs 62.5%%),pregnancy loss rate(53.3% vs 6.9%),intrauterine growth restriction(28.6%vs 11.9%),lupus nephritis activity(43.4% vs 15.6%),low complement C3 and C4 The incidence rate(46.7% vs 20.8%),the incidence of increased tit er of anti-DS-DNA antibody(60.0% vs 23.6%),and the quantitative level of24-hour urinary protein(2.10±3.11 g vs 0.46±1.02)were significantly higher in the non-planned pregnancy group than in the planned pregnancy group.The difference was statistically significant(P<0.05).2.The mean gestational age of SLE patients in the non-planned pregnancy group was(36.50±1.22)weeks,significantly lower than that in the planned pregnancy group(37.28±1.75)weeks,with statistical significance(P<0.05).3.The average daily use of glucocorticoids in non-planned pregnancy group was(12.25±2.81)mg,which was significantly higher than that in planned pregnancy group(8.58±2.33)mg,and the difference was statistically significant(P<0.05).4.In the non-planned pregnancy group,age,fever,alopecia,arthritis,oral ulcer,blood system damage,nervous system involvement,heart involvement,positive rate of anti-SM antibody,anti-SSA antibody and anti-SSB antibody,anti There was no significant difference in the positive rate of U1-RNP antibody,gestational hypertension,preeclampsia,premature rupture of membranes and fetal distress between the two groups(P>0.05).Conclusion: SLE pregnancy requires the risk of disease activity during pregnancy and adverse pregnancy outcom e.The disease activity and pregnancy loss rate of the planned pregnancy group were significantly lower than those of the unplanned pregnancy group.SLE patients can have children,before pregnancy must consult rheumatology and obstetrics to fully understand the disease status and drug use,under the guidance of the doctor to choose the right time of conception,do a good job of pregnancy plan,once pregnancy is determined,must strictly follow the doctor’s advice,not at will stop the drug,periodically review the relevant indicators to evaluate the condition,to ensure that can safely through the whole pregnancy.So as to get a good pregnancy outcome.Planned pregnancy of SLE pregnancy should be carried out after the disease has stabilized for more than ha lf a year,and multi-disciplinary collaboration such as rheumatology and immunology department and obstetricians is required to evaluate the maternal-fetal changes during pregnancy in order to obtain a good maternal-fetal outcome. |
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