Pregnancy outcomes in women with systemic sclerosis before and/or after diagnosis, and by parity - A Swedish population-based cohort study.

IF 10.9 1区 医学 Q1 RHEUMATOLOGY
Weng Ian Che,Luigi Annicchiarico,Laura Andreoli,Olof Stephansson,Marie Holmqvist,Karin Hellgren
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Abstract

OBJECTIVE To assess risks of adverse pregnancy outcomes (APO) in a contemporary cohort of women with systemic sclerosis (SSc) in relation to the timing of SSc diagnosis and by parity. METHODS From the nationwide Swedish Medical Birth Register, we assembled pregnancies with births in women with SSc and in comparator women from the general population 1998-2021. We classified pregnancies according to the timing of SSc diagnosis at birth: post-SSc; after SSc diagnosis (n=94), and pre-SSc; 0-3 years (n=39) or >3 years (n=839) before diagnosis of SSc. We used regression models estimating relative risks (RR) of APO in post-SSc, and odds ratios (OR) in pre-SSc pregnancies with 95% confidence interval (CI), respectively. RESULTS For post-SSc pregnancies, RR of preeclampsia (3.8; 1.8-7.8), preterm birth (3.3; 1.8-6.1), and caesarean delivery (2.5; 1.8-3.5) were increased. By contrast, there were no indications of increased proportions of maternal or neonatal death, nor stillbirth. Stratifying on parity, risks were considerably higher among primiparous post-SSc women; RR of preeclampsia (7.5; 3.5-16.1) and of preterm birth (5.1; 2.5-10.5). We also noted increased odds of APO in pre-SSc pregnancies, with the highest estimates in the 0-3 years pre-SSc pregnancies. CONCLUSION Contemporary women with SSc displayed markedly increased risks of several APO after SSc diagnosis; the risk of some APO was already increased before diagnosis, particularly within 3 years. Our findings suggest that both preclinical and overt SSc have a substantial impact on pregnancy outcomes, especially in the first pregnancy, highlighting the importance of specialized care and close monitoring.
系统性硬化症女性在诊断前和/或诊断后的妊娠结局,以及胎次——瑞典一项基于人群的队列研究
目的评估当代系统性硬化症(SSc)妇女队列中不良妊娠结局(APO)的风险与SSc诊断时间和胎次的关系。方法:从瑞典全国医疗出生登记册中,我们收集了1998-2021年SSc妇女和普通人群中怀孕分娩的对照妇女。我们根据出生时SSc诊断的时间对妊娠进行分类:SSc后;SSc诊断后(n=94)和SSc前;诊断为SSc前0 ~ 3年(n=39)或3 ~ 3年(n=839)。我们使用回归模型分别估计ssc后APO的相对风险(RR)和ssc前妊娠的比值比(OR),置信区间为95%。结果ssc后妊娠,子痫前期RR (3.8;1.8-7.8),早产(3.3;1.8-6.1)和剖宫产(2.5;1.8 ~ 3.5)升高。相比之下,没有迹象表明产妇或新生儿死亡比例增加,也没有死产。按胎次分层,ssc后初产妇的风险要高得多;子痫前期RR (7.5;3.5-16.1)和早产(5.1;2.5 - -10.5)。我们还注意到APO在ssc前怀孕的几率增加,在ssc前0-3年的估计最高。结论当代SSc女性在SSc诊断后出现多种APO的风险明显增加;一些APO的风险在诊断前已经增加,特别是在3年内。我们的研究结果表明,临床前和显性SSc对妊娠结局都有重大影响,特别是在第一次妊娠,强调了专业护理和密切监测的重要性。
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来源期刊
Arthritis & Rheumatology
Arthritis & Rheumatology RHEUMATOLOGY-
CiteScore
20.90
自引率
3.00%
发文量
371
期刊介绍: Arthritis & Rheumatology is the official journal of the American College of Rheumatology and focuses on the natural history, pathophysiology, treatment, and outcome of rheumatic diseases. It is a peer-reviewed publication that aims to provide the highest quality basic and clinical research in this field. The journal covers a wide range of investigative areas and also includes review articles, editorials, and educational material for researchers and clinicians. Being recognized as a leading research journal in rheumatology, Arthritis & Rheumatology serves the global community of rheumatology investigators and clinicians.
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