Maternal And Fetal Outcomes In Patients With Primary Sj（?）gren’s Syndrome Complicated With Pregnancy:A Retrospective Cohort Study

Background: To evaluate the effects of primary Sj（?）gren’s syndrome（p SS）on maternal and neonatal pregnancy outcomes,to explore the risk factors of pregnancy complications,fetal loss,early spontaneous abortion,premature delivery,adverse newborn,low birth weight infants and neonatal cardiovascular disease in primary sj（?）gren’s syndrome.Methods: The retrospective multicenter cohort study included 205 pregnancies of 158 patients with p SS and 410 pregnancies of health control from January 2012 to October2022.Baseline characteristics of pregnancy complications and maternal and fetal outcomes were compared between the two groups.The incidence and risk factors of pregnancy complications,fetal loss,early spontaneous abortion,premature delivery,adverse newborn,low birth weight and neonatal cardiovascular disease in p SS patients were analyzed.Data analysis was performed by SPSS software.Results: The results of univariate analysis of pregnancy outcomes of p SS pregnancy group showed that diagnosis time,renal tubular acidosis,anemia and anti-SSA60 antibody has statistically significant between the group with pregnancy complications and without pregnancy complications.Diagnosis time,pregnancy pathway,thyroid disease,anemia,pregnancy complications,pre-pregnancy lymphocytes absolute value,total glucosides of paeony（TGP）and iguratimod has statistically significant between the group with spontaneous abortion and without spontaneous abortion in early pregnancy.Disease duration,the number of pregnancy and abortion,diagnosis time,pregnancy way,thyroid disease,pregnancy complications,placental abnormalities,premature rupture of membranes,TGP,low molecular heparin,aspirin and euthyrox has statistically significant between live birth and fetal loss.Adverse pregnancy history,pregnancy way,glucocorticoids,pregnancy complications,placental abnormalities,premature rupture of membranes and pregnancy eclampsia/preeclampsia has statistically significant between term infant and premature infant.Diagnosis time,pregnancy way,thrombocytopenia,glucocorticoid and pregnancy complications were statistically significant between the neonatal health group and the neonatal adverse group.Delivery gestational age,pregnancy way,cyclosporine A（Cs A）,r-globulin,pregnancy complications and pregnancy eclampsia/preeclampsia were significant difference between the low birth weight infants group and the no low birth weight infants group.There was statistically significant difference between the abnormal cardiovascular group and the normal group in delivery gestational age,pregnancy complications,anti-SSA60 antibody,cyclosporine and ursodeoxycholic acid.Logistic regression analysis showed that the risk factors for pregnancy complications in patients with p SS were the time of diagnosis of p SS,anemia during pregnancy and positive anti-SSA60 antibody（OR=3.198,P=0.036;OR=3.085,P=0.010;OR=5.956,P=0.033）.The use of low molecular weight heparin and euthyrox during pregnancy were protective factors for fetal loss（OR=0.249,P=0.035;OR=0.167,P=0.008）.Pregnancy after treatment was more prone to fetal loss than natural conception（OR=4.240,P=0.017）.Administration of TGP during pregnancy was a risk factor for fetal loss and spontaneous abortion in early pregnancy（OR=4.050,P=0.003;OR=16.693,P<0.001）.The use of >10mg prednisone（or equivalent glucocorticoid）during pregnancy,premature rupture of membranes and abnormal placenta were risk factors for premature delivery（OR=8.528,P=0.026;OR = 8.475,P = 0.001;OR =12.482,P<0.001）.The risk factors for adverse neonatal outcomes were ART-assisted conception,use of > 10 mg prednisone（or equivalent glucocorticoid）during pregnancy and pregnancy complications（OR=3.930,P=0.009;OR=7.243,P = 0.039;OR=5.801,P=0.003）;Postnatal diagnosis of p SS was a protective factor for adverse neonatal outcomes（OR=0.064,P=0.029）.The protective factor of low birth weight infants was gestational age at delivery（OR=0.827,P<0.001）.Risk factors for neonatal cardiovascular abnormalities were complications during pregnancy and cyclosporine use during pregnancy（OR=3.565,P=0.015;OR=10.974,P=0.043）.Conclusions: p SS is a high-risk pregnancy condition associated with significant pregnancy complications and poor maternal-fetal outcomes.Women with p SS should be guaranteed throughout the pre-pregnancy,pregnancy and postpartum period under multidisciplinary monitoring to reduce the incidence of adverse pregnancy outcomes.