The Impact of Pregnancy Readiness on Lupus Activity, Maternal Mental Health, and Pregnancy Outcomes.

IF 3.7 2区 医学 Q1 RHEUMATOLOGY
Ceshae C Harding, Amanda M Eudy, Cathrine A Sims, Cuoghi Edens, Mehret Birru Talabi, Rosalind Ramsey-Goldman, Laura Neil, Megan E B Clowse
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Abstract

Objective: Among individuals with systemic lupus erythematosus (SLE) who became pregnant, we explored the impact of medical readiness for pregnancy and personal readiness for pregnancy on the following aspects of maternal health: (1) provider-reported disease activity, (2) patient-perceived disease activity, (3) mood symptoms, (4) pregnancy-related health behaviors, and (5) pregnancy outcomes.

Methods: All study participants were enrolled in a prospective registry, met Systemic Lupus Collaborating Clinics (SLICC) criteria for SLE, and had at least one pregnancy. Patient-reported outcomes were collected at the first rheumatology visit during pregnancy. "Medically ready" for pregnancy was defined as (1) <1 g of proteinuria, (2) no rheumatic teratogens at conception, and (3) continuing pregnancy-compatible SLE medications after conception. "Personally ready" was defined as planned pregnancy based on a London Measure of Unplanned Pregnancy score ≥10. Multivariable logistic regression models estimated the association of pregnancy readiness with each outcome of interest.

Results: Among the 111 individuals enrolled, lack of medical readiness for pregnancy was associated with significantly higher rates of active disease and worse pregnancy outcomes; however, these patients did not perceive themselves as having higher disease activity. Lack of personal readiness for pregnancy was associated with significantly higher patient-perceived disease activity. Although medical readiness did not impact depressive symptoms substantially, lack of personal readiness for pregnancy was associated with much higher maternal depressive symptoms.

Conclusion: To improve pregnancy outcomes among individuals with SLE, greater focus is needed on improving medical optimization before conception. For maternal mental health and quality of life, greater focus is needed on decreasing the incidence of unplanned pregnancy.

妊娠准备对红斑狼疮活动、孕产妇心理健康和妊娠结果的影响。
目的:在怀孕的系统性红斑狼疮患者中,我们探讨了怀孕的医疗准备和个人准备对孕产妇健康以下方面的影响:(1)提供者报告的疾病活动;(2)患者感知的疾病活动;(3)情绪症状;(4)与怀孕相关的健康行为;以及(5)妊娠结局:方法:所有参与研究的人员都在前瞻性登记处登记,符合 SLICC 系统性红斑狼疮标准,并至少有一次妊娠。患者报告的妊娠结果是在妊娠期首次风湿病就诊时收集的。妊娠 "医学上已准备就绪 "的定义是:(1)结果:在登记的 111 名患者中,未做好怀孕的医疗准备与疾病活动率明显升高和妊娠结局恶化有关;但这些患者并不认为自己的疾病活动率升高。个人对怀孕准备不足与患者认为的疾病活动度明显升高有关。虽然医疗准备并不会对抑郁症状产生重大影响,但缺乏怀孕的个人准备却与孕产妇抑郁症状明显增加有关:结论:为了改善系统性红斑狼疮患者的妊娠结局,需要更加重视改善受孕前的医疗优化。结论:为了改善系统性红斑狼疮患者的妊娠结局,需要更加关注受孕前的医疗优化;为了提高孕产妇的心理健康和生活质量,需要更加关注降低意外妊娠的发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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