| Objectives: By collecting and comparing the pregnancy outcomes of pregnant women with Systemic lupus erythematosus(SLE)and healthy pregnant women,To analyze the clinical features,laboratory examination results and drug use of SLE patients with pregnancy,study the characteristics of SLE activities during pregnancy and its influence on pregnancy outcome,and find out the risk factors affecting the adverse pregnancy outcome of SLE patients,so as to strengthen the guidance and management of SLE patients during pregnancy and improve their pregnancy outcome.Methods: We collected the clinical data of patients diagnosed as pregnancy complicated with SLE from 2013 to 2022 in The Second Affiliated Hospital of Kunming Medical University.And followed up the Neonatal lupus(NL)and Congenital heart block(CHB)of the offspring of the above patients by telephone.At the same time,200 non-SLE pregnant women in our hospital were randomly selected as the control group for retrospective analysis.By comparing the pregnancy outcomes of SLE patients and healthy pregnant women,analyze the clinical characteristics of SLE pregnant patients and the risk factors of adverse pregnancy outcomes.T-test,Mann Whitney U test,Chi-square test or Fisher exact probability method was used for statistical analysis.Multivariate binary logistic stepwise regression analysis was used to determine the risk factors of adverse pregnancy outcome in SLE pregnant patients.P < 0.05 indicated that the difference was statistically significant.Results: 1.There were total of 341 pregnant women in this study,including141 SLE patients with pregnancy and 200 healthy pregnant women.Through comparative analysis,we found that the hospitalization days and cesarean section rate of SLE patients were significantly higher than those of healthy pregnant women,while the gestational weeks of termination were significantly smaller than those of healthy pregnant women.In addition,adverse pregnancy outcomes of SLE patients include pregnancy complicated with preeclampsia,Pregnancy loss,There are obvious differences in pregnancy complicated with hypertension,thrombocytopenia,leukopenia,anemia,lymphocytopenia,hypoproteinemia,24-hour urinary protein >0.5 g during pregnancy,elevated fetal umbilical artery blood flow ratio,oligohydramnios,fetal growth restriction,premature delivery,low birth weight and neonatal asphyxia.2.Among the pregnancy cases of SLE,there are 40 cases(28.37%)in active SLE group and 101 cases(71.63%)in stable SLE group.13 cases of SLE at the beginning of pregnancy,and 84 cases had adverse pregnancy history.There were 24 cases(17.02%)of pregnancy loss,36 cases(30.77%)of natural delivery,81 cases(69.23%)of cesarean section,38 cases(32.48%)of premature delivery,56 cases(48.74%)of low birth weight infants and 19 cases(13.48%)of preeclampsia.The hospitalization days of active SLE group were significantly longer than those of stable SLE group,and the gestational weeks of termination of pregnancy were also shorter than those of stable SLE group.The risk of thrombocytopenia,preeclampsia,pregnancy loss,new Lupus nephritis(LN)and hypoproteinemia in SLE active group was significantly higher than that in SLE stable group.3.Most SLE patients take hormone,hydroxychloroquine or immunosuppressant to control their illness during pregnancy.There are statistical differences between SLE active group and SLE stable group in taking hormone > 15 mg,hydroxychloroquine and aspirin.The number of patients taking hormone > 15 mg in SLE active group is significantly higher than that in SLE stable group,and the proportion of oral hydroxychloroquine in pregnancy is higher than that in SLE active group.In this study,5 patients stopped taking drugs during pregnancy,and finally 3 patients suffered from pregnancy loss and 2 patients were active during pregnancy.4.Multivariate logistic stepwise regression model was used to analyze the risk factors of preeclampsia,pregnancy loss,premature delivery and low birth weight infants during pregnancy.The independent risk factor of low birth weight infants was preeclampsia during pregnancy(OR=7.569,95% CI 1.532-37.408,P=0.013);The independent risk factors of pregnancy loss were rural area(OR=3.944,95% CI1.306-11.915,P=0.015),positive anti-ds DNA antibody(OR=4.352,95% CI 1.313-14.417,P=0.016),positive anticardiolipin antibody(OR=3.434,95% CI 1.277-9.235,P=0.015),premature birth LN(OR=35.064,95% CI 4.149-296.333,P=0.001),abortion times ≥ 2(OR=3.352,95% CI 1.312-8.561,P=0.011),PE activity(OR=34.241,95% CI 6.040-194.108,P<0.001),lupus anticoagulant positive(OR=6.707,95% CI: 1.420-31.689,P=0.016).Conclusions:1.The risk of adverse pregnancy outcome in SLE patients with pregnancy is significantly higher than that in healthy pregnant women.2.The risk of adverse pregnancy outcome will further increase when SLE patients have disease activity during pregnancy,and some patients have SLE during pregnancy,which needs close monitoring.3.The independent risk factors of pregnancy loss in SLE patients are that the patients come from rural areas and are positive for anticardiolipin antibody and antids DNA antibody;The independent risk factors of PE include positive lupus anticoagulant and SLE activity during pregnancy.The risk factors of premature delivery were LN and abortion times ≥ 2,and the risk factors of low birth weight infants were pregnancy complicated with preeclampsia.4.Pregnancy complicated with SLE is a high-risk pregnancy,which requires rheumatologists and obstetricians to supervise pregnancy together,and patients’ compliance is also very important in this process. |
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