Analysis Of Related Factors Of Adverse Pregnancy Outcome In Patients With Systemic Lupus Erythematosus

Objective:This study analyzed the clinical data of pregnancy patients with systemic lupus erythematosus(SLE)to explored the clinical factors related to the adverse pregnancy outcome of SLE patients.The knowledge can help for clinicians to guide the pregnancy of SLE patients.Methods:We retrospectively analyzed the clinical data of 64 cases of with SLE who were hospitalized in the first Hospital of Jilin University from January 2005 to March2019.We analyzed the general situation,history,laboratory examination,therapy and fetal information.The relevant conclusions are drawn by using the method of statistical analysis.Results:1.A total of 64 SLE pregnant patients were included in this study.there were18 cases(28.1%)of lupus nephritis,17 cases(26.6%)of moderate to severe disease activity,15 cases(23.4%)of hypertensive disorder complicating pregnancy and 1case of HELLP syndrome(1.6%)inthese people.There were 37 cases(57.8%)of fetal adverse pregnancy outcome,including 22 cases of pregnancy loss(34.4%),15 cases of premature delivery(23.4%),8 cases of fetal distress(12.5%)and 3 cases of IUGR(4.7%).2.In this study,49 patients with SLE were diagnosed before pregnancy.According to the adverse pregnancy outcome of the fetus,we were divided into two groups.Comparing the clinical characteristics of the two groups,it was found that the proportion of patients with lupus nephritis,who did not receive hydroxychloroquine,complement reduction and proteinuria > 0.5g/24 h in the group with fetal adverse pregnancy outcome was higher than the other one.The SLEDAI score was higher in the group with fetal adverse pregnancy outcome.The difference was statisticallysignificant(P < 0.05).Multivariate Logistic regression analysis showed that the complement reduction(OR 55.95,95%CI 5.98-523.19,P=0.001)was an independent risk factor for adverse fetal pregnancy outcome and Hydroxychloroquine treatment during pregnancy(OR 0.06,95%CI 0.01-0.59,P=0.015)was a protective factor for adverse fetal pregnancy outcomes.3.Of the 49 patients with SLE diagnosed before pregnancy,they were divided into live birth group and pregnancy loss group according to whether the fetus survived or not.Comparing the clinical characteristics of the two groups,it was found that the SLEDAI score of pregnancy loss group was higher than that another group.The proportion of patients with lupus nephritis,without hydroxychloroquin treatment,thrombocytopenia,complement reduction,and anti-SSB antibody(+)was significantly higher than that in the live birth group(P < 0.05).Multivariate Logistic regression analysis showed that complement reduction(OR 13.37,95%CI1.26-142,23,P=0.032)and thrombocytopenia(OR 5.84,95%CI 1.40-105.02,P=0.046)was an independent risk factor for fetal pregnancy loss.4.Comparing preterm delivery with full term delivery,it was found that the body mass index and SLEDAI score in premature delivery group were higher than another group.The proportion of patients who did not receive hydroxychloroquine treatment,complement reduction and proteinuria > 0.5g/24 h during pregnancy in the premature delivery group was higher than that in the full-term delivery group.The difference was statistically significant(P < 0.05).5.It was found that there were significant differences in age and pregnancy cycle between the two groups of patients with SLE diagnosed before pregnancy and new-onset SLE in pregnant patients(P < 0.05).At the same time,the patients with new-onset SLE in pregnant patients had higher SLEDAI score and lower neonatal Apgar(1min)score,and the proportion of patients with lupus nephritis and hypertensive disorder complicating pregnancy.And the proportion of fetal adverse pregnancy outcome,pregnancy loss and fetal distress in the new-onset SLE in pregnant patients was higher than that another group.Conclusions:1.The main adverse pregnancy outcomes of SLE patients are pregnancy loss and preterm delivery.2.The treatment of hydroxychloroquine during pregnancy in SLE pregnancy is the protective factor of fetal adverse pregnancy outcome,and The decrease of complement has a certain reference value for predicting the occurrence of adverse pregnancy outcome.3.The decrease of complement and thrombocytopenia during pregnancy in SLE patients have certain significance in predicting the loss of fetal pregnancy.4.Compared with previously diagnosed SLE patients,patients with new-onset SLE in pregnant patients were more likely to have adverse pregnancy outcomes.