Pregnancy outcomes in connective tissue diseases: a 30-year study of 465 cases from a single-center Spanish registry with insights on hydroxychloroquine use.
Cristiana Sieiro Santos, José Ordás Martínez, Clara Moriano Morales, Carolina Alvarez Castro, Elvira Díez Álvarez
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引用次数: 0
Abstract
Introduction: Pregnancy in women with connective tissue diseases (CTDs), including systemic lupus erythematosus (SLE), systemic sclerosis (SSc), primary Sjögren's syndrome (pSS), and undifferentiated connective tissue disease (UCTD), poses significant risks for adverse outcomes. Evaluating these risks and outcomes is essential to improve maternal and fetal health.
Objectives: This study aimed to assess pregnancy outcomes in patients with CTDs, identify factors associated with adverse outcomes, and evaluate the protective effects of hydroxychloroquine (HCQ) treatment.
Methods: A study covering the period from 1990 to 2022 was conducted. Data were collected from medical records of childbearing-age women with SLE, SSc, pSS, and UCTD who were under care at our clinic. Obstetric, maternal, and fetal outcomes were analyzed across different diagnoses. Statistical analyses were performed to identify associations between disease activity, treatments, and pregnancy outcomes.
Results: A total of 295 patients (125 with SLE, 50 with SSc, 80 with pSS, and 40 with UCTD) and 465 pregnancies were included. The mean age at first pregnancy was 29.1±9.1 years. Pregnancy loss occurred in 21% of cases, while 77% resulted in live births. Adverse outcomes included preterm delivery (8%), postpartum hemorrhage (6%), and preeclampsia (5%). SLE diagnosis (OR 1.5, 95% CI [1.1-4.8], p = 0.03), double/triple antiphospholipid antibody (APL) positivity (OR 2.3, 95% CI [1.1-3.9], p = 0.04), and active disease (OR 3.4, 95% CI [1.8-5.2], p = 0.004) were identified as risk factors for adverse pregnancy outcomes. HCQ treatment demonstrated a protective effect (OR 0.34, 95% CI [0.05-0.72], p = 0.0004).
Conclusion: Two-thirds of pregnancies in women with CTDs resulted in live births, though SLE was associated with significantly higher risks. Active disease during pregnancy emerged as a major risk factor. Importantly, the use of HCQ was associated with a notable reduction in these risks, underscoring its protective role in improving pregnancy outcomes. These findings highlight the critical importance of preconception counseling, careful disease management, and the proactive use of HCQ to minimize complications and optimize outcomes in pregnancies complicated by CTDs.
结缔组织疾病(CTDs),包括系统性红斑狼疮(SLE)、系统性硬化症(SSc)、原发性Sjögren’s综合征(pSS)和未分化结缔组织疾病(UCTD)的妇女妊娠,具有显著的不良结局风险。评估这些风险和结果对于改善孕产妇和胎儿健康至关重要。目的:本研究旨在评估CTDs患者的妊娠结局,确定与不良结局相关的因素,并评估羟氯喹(HCQ)治疗的保护作用。方法:选取1990 ~ 2022年为研究对象。数据收集自在我们诊所接受治疗的育龄SLE、SSc、pSS和UCTD妇女的医疗记录。分析了不同诊断的产科、产妇和胎儿结局。进行统计分析以确定疾病活动、治疗和妊娠结局之间的关联。结果:共纳入295例患者(SLE 125例,SSc 50例,pSS 80例,UCTD 40例)和465例妊娠。平均初孕年龄为29.1±9.1岁。21%的病例流产,77%的病例活产。不良结局包括早产(8%)、产后出血(6%)和先兆子痫(5%)。SLE诊断(OR 1.5, 95% CI [1.1-4.8], p = 0.03)、双/三重抗磷脂抗体(APL)阳性(OR 2.3, 95% CI [1.1-3.9], p = 0.04)和活动性疾病(OR 3.4, 95% CI [1.8-5.2], p = 0.004)被确定为不良妊娠结局的危险因素。HCQ治疗显示出保护作用(OR 0.34, 95% CI [0.05-0.72], p = 0.0004)。结论:三分之二的CTDs妊娠导致活产,尽管SLE的风险明显更高。妊娠期活动性疾病是一个主要的危险因素。重要的是,使用HCQ与这些风险的显著降低有关,强调了其在改善妊娠结局方面的保护作用。这些发现强调了孕前咨询、仔细的疾病管理和积极使用HCQ以减少并发症和优化CTDs合并妊娠结局的重要性。