妊娠对类风湿关节炎患者未来健康的影响：文献系统综述

IF 9.2 1区医学 Q1 IMMUNOLOGY

Autoimmunity reviews Pub Date : 2025-04-08 DOI:10.1016/j.autrev.2025.103808

Bethan Goulden , George Woodward , Sophie Leiner , Zahra Ahmed , Sophie Covington , Diane Nzelu , Radboud Dolhain , Ian Giles

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引用次数: 0

摘要

目的评估产科史是否能预测未来类风湿关节炎（RA）的诊断、严重程度和/或产后后的产妇健康状况。方法系统检索24年7月1日的文献（PubMed, Embase）；普洛斯彼罗id crd42024559893。根据ra发病前或发病后的产科史分层，对ra影响女性的健康结果进行了初步研究。如果报告的暴露/结果不同，则纳入重叠队列的研究。结果在筛选的3333篇文献中，筛选出95篇研究。分析的未来健康结果包括RA诊断（n = 66项研究）、严重程度（n = 11）、心血管疾病（n = 2）、免疫力（n = 9）和微嵌合（n = 7）。胎次/妊娠（n = 67）、不孕症（n = 7）和妊娠丢失（n = 22）不是后续RA的可靠预测因素。在受ra影响的女性中，高胎次（n = 2）与心血管疾病风险增加有关。先兆子痫（n = 4）和低出生体重儿（n = 2）与RA诊断/严重程度相关。有趋势表明，早产（n = 3）和严重妊娠剧吐（n = 3）后RA风险增加，但妊娠糖尿病（n = 1）后RA风险增加。产后6个月后血清蛋白翻译后修饰无显著差异，但抗hla抗体和微嵌合持续存在差异。结论研究表明胎次、妊娠、不孕和妊娠丢失对RA的发展没有不利影响。相反，低出生体重分娩与RA诊断和严重程度相关，而先兆子痫与随后的RA诊断相关。免疫反应的差异，如抗hla和微嵌合所显示的，可能表明与RA发病有关的免疫致敏。先兆子痫和妊娠糖尿病对ra女性心血管健康的预测影响尚未研究。

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The impact of pregnancy on future health in Rheumatoid Arthritis: A systematic review of the literature

Objectives

To assess whether obstetric history predicts future rheumatoid arthritis (RA) diagnosis, severity, and/or maternal health beyond the immediate postpartum period.

Methods

A systematic literature search was conducted on 01/07/24 (PubMed, Embase); PROSPERO ID CRD42024559893. Primary research examining health outcomes in RA-affected females, stratified on obstetric history pre- or post-RA onset, were selected for inclusion. Studies of overlapping cohorts were included if differing exposures/outcomes reported.

Results

Out of 3333 articles screened, 95 studies were selected. Future health outcomes analysed included RA diagnosis (n = 66 studies), severity (n = 11), cardiovascular disease (n = 2), immunity (n = 9), and microchimerism (n = 7). Parity/gravidity (n = 67), infertility (n = 7), and pregnancy loss (n = 22) were not reliable predictors of subsequent RA. High parity (n = 2) was linked to increased cardiovascular disease risk in RA-affected females. Both pre-eclampsia (n = 4) and delivery of a low birthweight infant (n = 2) were associated with RA diagnosis/severity. A trend suggested increased RA risk after preterm birth (n = 3) and severe hyperemesis gravidarum (n = 3), but not for gestational diabetes (n = 1). No significant differences in post-translational modification of serum proteins were noted beyond 6 months postpartum, though persistent differences in anti-HLA antibodies and microchimerism were observed.

Conclusions

Research indicates that parity, gravidity, infertility, and pregnancy loss do not adversely affect RA development. Conversely, low birthweight delivery was associated with RA diagnosis and severity, while pre-eclampsia correlated with subsequent RA diagnosis. Differences in immune responses, as indicated by anti-HLA and microchimerism, may indicate immune sensitisation relevant to RA pathogenesis. The predictive impact of pre-eclampsia and gestational diabetes on cardiovascular health in RA-affected females remains unstudied.

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来源期刊

Autoimmunity reviews 医学-免疫学

CiteScore

24.70

自引率

4.40%

发文量

164

审稿时长

21 days

期刊介绍： Autoimmunity Reviews is a publication that features up-to-date, structured reviews on various topics in the field of autoimmunity. These reviews are written by renowned experts and include demonstrative illustrations and tables. Each article will have a clear "take-home" message for readers. The selection of articles is primarily done by the Editors-in-Chief, based on recommendations from the international Editorial Board. The topics covered in the articles span all areas of autoimmunology, aiming to bridge the gap between basic and clinical sciences. In terms of content, the contributions in basic sciences delve into the pathophysiology and mechanisms of autoimmune disorders, as well as genomics and proteomics. On the other hand, clinical contributions focus on diseases related to autoimmunity, novel therapies, and clinical associations. Autoimmunity Reviews is internationally recognized, and its articles are indexed and abstracted in prestigious databases such as PubMed/Medline, Science Citation Index Expanded, Biosciences Information Services, and Chemical Abstracts.