Clinical Analysis Of 79 Cases Of Pregnant Outcome With Systemic Lupus Erythematosus

Objective According to the analysis of the clinical characteristics and pregnancy outcome of Systemic lupus erythematosus(SLE)complicated with pregnancy,the appropriate timing of pregnancy and pregnancy management were suggested to prevent the disease deterioration and adverse pregnancy outcome of SLE patients.Methods The clinical data of 79 pregnant women with SLE treated in the First Affiliated Hospital of Bengbu Medical College between October 2016 and July 2018 were collected and analyzed retrospectively.According to SLE disease activity index(SLEDAI),the patients were divided into non-selective pregnancy group(n=37)and selective pregnancy group(n=42).Inclusion criteria for the selective pregnancy group:The score is less than or equal to 4 points,Patients with systemic treatment for disease remission for more than half a year and no cytotoxic drug application within nearly half a year,and patients requiring oral prednisone 5~15 mg/d to maintain stable condition but no SLE activity expression were included in the selective pregnancy group.Inclusion criteria for the non-selective pregnancy group: Scores greater than or equal to 5 points,Among them,5 ~ 9 were classified as mild activities.10 ~14 pointsis divided into moderate activities.More than 15 points is a serious activity.These include patients who are newly diagnosed with SLE after pregnancy and conceive without a doctor's evaluation.By comparing the general situation of the patients,the symptoms,signs,medication,laboratory examination results before and during pregnancy,the gestational weeks of newborns,fetal weight,complications during hospitalization and so on,the clinical characteristics and pregnancy outcomes were summarized and analyzed.Results 1?The disease activity rate(86.5% vs 28.6%),pregnancy loss rate(32.4% vs4.8%),premature delivery rate(54.1% vs 16.7%),premature rupture of membranes(27.0% vs 2.4%),intrauterine growth restriction(30.8% vs 4.8%),preeclampsia(10.8%vs 0.0%),active lupus nephritis(37.8% vs 7.1%),skin damage(43.2% vs 11.9%),low complement C3 and C4 incidence(48.6% vs.21.4%),the incidence of increased anti-ds-DNA antibody titers(59.5% vs 28.6%)in non-selective pregnancy group was higher than that in selective pregnancy group(P < 0.05).2?Compared with the gestational weeks [(35.04 2.90)w vs(38.10 0.76)w],the fetal birth weight [(2586.15 743.27)g vs(3230.00 395.63)g],the proportion ofhydroxychloroquine(32.4% vs 69.0%)and glucocorticoid(43.2% vs 71.4%)in the non-selective pregnancy group and the selective pregnancy group,the differences were statistically significant(P<0.05).3?In the non-selective pregnancy group,age,course of disease,times of pregnancy,fever,alopecia,arthritis,anemia,thrombocytopenia,Reynolds phenomenon,positive rate of anti-SSA antibody and anti-SSB antibody,Positive rate of anti-RNP antibody,pregnancy hypertension,preeclampsia,fetal distress,neonatal lupus syndrome,neonatal respiratory distress syndrome,congenital heart disease,congenital rickets and other aspects of selective pregnancy were observed.There was no significant difference between the two groups(P>0.05).Conclusion SLE patients with pregnancy are at risk of disease activity and adverse pregnancy outcomes during pregnancy,but the activity and pregnancy loss rate of the selective pregnancy group are lower than those of the non-selective pregnancy group.Under the treatment and observation of rheumatologists and obstetricians,the maternal and infant outcomes of non-active pregnancy can be better.