| Background Systemic lupus erythematosus(SLE)is a chronic autoimmune disease that has repeated migrations and mainly affects women of childbearing age.Compared with peers without SLE,the fertility of SLE patients has no difference.However,in the past,it is not been advised to pregnant women with SLE,SLE pregnancy are considered high risk.Sex hormones play a role in the pathogenesis of SLE,and the chance of SLE relapse are increasing during the pregnancy.Therefore,a part of SLE women will terminate pregnant process.Most studies have shown an increased risk of developing SLE during pregnancy.Pregnancy provides a special physiological and pathological environment for the incidence of SLE.Autoimmune diseases interact with immune regulation and changes in the physiological environment during pregnancy,resulting in an increased risk of adverse pregnancy outcomes(APOs)for pregnant women and fetuses.These include preeclampsia/eclampsia(PE),premature birth,abortion and Intrauterine growth restriction(IUGR).Predictors of preeclampsia/eclampsia in SLE patients include lupus nephritis(LN),high disease activity,antiphospholipid antibody(a PL),and decreased complement levels.At present,studies on the risk of adverse pregnancy outcomes in SLE pregnancy are different,and due to differences in study design and sample size,the results are not consistent.In addition,the impact of SLE on pregnancy outcomes remains unclear and needs to be further explored due to ethnic differences in SLE incidence and different levels of access to healthcare management in different regions.Objectives By comparing the pregnancy and healthy control of SLE patients,this study aims to understand the complications during pregnancy and maternal and fetal outcomes of SLE disease changes,and further explore the influencing factors of APOs in SLE patients.Methods This study is based on the hospital case-control study,data source is diagnosis of pregnancy from February 2010 to September 2018 the first affiliated hospital of Anhui medical university and the university of science and technology of China,the first affiliated hospital with a total of 268 patients with SLE,and at the same time period,the healthy controls of random selection in hospitals,a total of 311 cases of confirmed,determine the difference between SLE patients and normal pregnant women about pregnancy complications and APOs,and explore the possible risk factors of APOs.The study design is mainly divided into two parts:The First Stage: Firstly,579 pregnancies were analyzed,268 SLE pregnancies were compared with 311 normal healthy pregnant women.Collect information including pregnancy with basic situation,reproductive history,treatment records,the condition of autoantibodies and general laboratory examination,pregnancy outcomes and obstetric outcomes,normal control group mainly include basic information collection of healthy pregnant women,reproductive history,general and laboratory examination,the condition of pregnancy,the pregnancy outcomes and obstetrical outcomes.The Second Stage: The pregnancy process of SLE patients was further analyzed.By analyzing the influence of the presence of autoantibodies,fertility history,medication status and pregnancy status on pregnancy outcome,a multi-factor analysis of pregnancy outcome and influencing factors was conducted.Outcomes A total of 579 pregnant women were included in this study,including 268 SLE patients,including 311 normal healthy pregnant women.Adverse pregnancy outcomes in pregnant women,selective cesarean section in 337 patients,12 cases of placenta previa,premature rupture of membranes,56 cases,39 cases of oligohydramnios,pregnancy with thrombocytopenia,8 cases of pregnancy with anemia in 16 cases,eclampsia/severe preeclampsia 27 cases,22 cases of pregnancy with hypothyroidism,14 cases of gestational hypertension,gestational diabetes,32 cases HELLP syndrome(3 cases);Among the adverse outcomes of fetal pregnancy,73 cases of premature delivery,45 cases of low birth weight,14 cases of macrosomia,5 cases of intrauterine distress,and24 cases of fetal growth restriction.There were significant differences between SLE pregnant women and normal healthy pregnant women in selective cesarean section,pregnancy with anemia,eclampsia,pregnancy with hypothyroidism,and gestational hypertension(P<0.05).The risk of elective cesarean section in SLE patients was 10.4times higher than that in the healthy group;anemia associated with pregnancy in SLE patients was 8.5 times higher than that in healthy pregnant women;eclampsia associated with SLE pregnancy/severe eclampsia associated with SLE pregnancy was 3.5 times higher than that in healthy pregnant women;hypothyroidism associated with pregnancy was 2.6 times higher than that in healthy pregnant women;and hypertension associated with pregnancy was 7.2 times higher than that in healthy pregnant women.Among adverse fetal pregnancy outcomes,there were significant differences between SLE patients and healthy pregnant women in preterm birth,low weight infants,macrosomia and fetal growth restriction,among which the risk of preterm birth,low weight infants and fetal growth restriction was 9.25,2.4 and 13.8 times higher than the risk of adverse outcome of healthy pregnancy.Binary Logistic regression analysis showed that positive anti-ANA antibody was significantly correlated with the occurrence of maternal adverse pregnancy outcomes;LN was significantly associated with adverse pregnancy outcomes in the fetus.Conclusions1.Adverse pregnancy outcomes are more likely to occur in SLE pregnant women than in healthy pregnant women.Outcomes such as selective cesarean section,pregnancy with anemia,eclampsia,pregnancy with hypothyroidism,gestational hypertension,preterm delivery,low-weight infants,macrosomia,and fetal growth restriction are more likely to occur in SLE pregnant women during pregnancy.2.The diagnosis,treatment and management level of SLE patients at childbearing age in China has been improved to ensure a lower disease activity during pregnancy,and the success rate of SLE pregnancy has been significantly improved. |
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