{"title":"SLE患者不良母婴结局的危险因素：一项系统回顾和荟萃分析。","authors":"Hang Liu, Meifei Li, Meijiao Wang, Minzhe Ren, Jiaying Fu, Ying Cai, Zhiyu Li, Ting Zhao, Jing Sun, Zhijun Xie","doi":"10.3389/fmed.2025.1573573","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that increases the risk of adverse maternal and fetal outcomes in SLE pregnancies. Identifying potential risk factors can enhance preconception risk assessment for SLE pregnancies, thereby reducing the burden of pregnancy for SLE patients.</p><p><strong>Objective: </strong>The goal of this meta-analysis is to designate the risk factors for unfavorable maternal and fetal outcomes in SLE pregnancies by means of a systematic review of the literature and meta-analysis.</p><p><strong>Methods: </strong>The odds ratios (ORs) and associated 95% confidence intervals (CIs) were estimated using either a fixed-effects model or a random-effects model. The I<sup>2</sup> statistic was used to assess heterogeneity. Sensitivity analysis, Egger's test, the Newcastle-Ottawa Quality Assessment Scale (NOS), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system were also performed.</p><p><strong>Results: </strong>Eleven papers with 1,790 SLE patients who were pregnant were examined in the meta-analysis out of 2,467 citations that were screened. The meta-analysis's findings indicated that the onset of SLE is associated with an increased risk of preterm birth (OR: 2.85; 95% CI: 2.04, 3.99). Hypertension is associated with an increased risk of composite pregnancy outcomes (OR: 4.56; 95% CI: 2.42, 8.53), preterm birth (OR: 2.20; 95% CI: 1.53, 3.17) and preeclampsia (OR: 10.11; 95% CI: 1.83, 55.89). Renal involvement is associated with an increased risk of composite pregnancy outcomes (OR: 3.09; 95% CI: 1.66, 5.72) and preterm birth (OR: 1.65; 95% CI: 1.22, 2.23). Anti-dsDNA is associated with an increased risk of preterm birth (OR: 1.83; 95% CI: 1.13, 2.92) and pregnancy loss (OR: 2.64; 95% CI: 1.09, 6.40). Drug therapy is associated with a decreased risk of composite pregnancy outcomes (OR: 0.51; 95% CI: 0.31, 0.85), preterm birth (OR: 0.66; 95% CI: 0.48, 0.89) and pregnancy loss (OR: 0.42; 95% CI: 0.21, 0.84). Sensitivity analysis demonstrated how solid our results are. Egger's test revealed no discernible publication bias.</p><p><strong>Conclusion: </strong>The onset of SLE, hypertension, renal involvement, drug therapy, and serological factors have a predictive effect on the occurrence of adverse maternal and fetal outcomes in SLE pregnancies. Strengthening preconception risk assessment for SLE patients plays an important role in reducing pregnancy risks and improving the quality of life during pregnancy.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42024564190.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1573573"},"PeriodicalIF":3.1000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504262/pdf/","citationCount":"0","resultStr":"{\"title\":\"Risk factors for adverse maternal and fetal outcomes in SLE patients: a systematic review and meta-analysis.\",\"authors\":\"Hang Liu, Meifei Li, Meijiao Wang, Minzhe Ren, Jiaying Fu, Ying Cai, Zhiyu Li, Ting Zhao, Jing Sun, Zhijun Xie\",\"doi\":\"10.3389/fmed.2025.1573573\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that increases the risk of adverse maternal and fetal outcomes in SLE pregnancies. Identifying potential risk factors can enhance preconception risk assessment for SLE pregnancies, thereby reducing the burden of pregnancy for SLE patients.</p><p><strong>Objective: </strong>The goal of this meta-analysis is to designate the risk factors for unfavorable maternal and fetal outcomes in SLE pregnancies by means of a systematic review of the literature and meta-analysis.</p><p><strong>Methods: </strong>The odds ratios (ORs) and associated 95% confidence intervals (CIs) were estimated using either a fixed-effects model or a random-effects model. The I<sup>2</sup> statistic was used to assess heterogeneity. Sensitivity analysis, Egger's test, the Newcastle-Ottawa Quality Assessment Scale (NOS), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system were also performed.</p><p><strong>Results: </strong>Eleven papers with 1,790 SLE patients who were pregnant were examined in the meta-analysis out of 2,467 citations that were screened. The meta-analysis's findings indicated that the onset of SLE is associated with an increased risk of preterm birth (OR: 2.85; 95% CI: 2.04, 3.99). Hypertension is associated with an increased risk of composite pregnancy outcomes (OR: 4.56; 95% CI: 2.42, 8.53), preterm birth (OR: 2.20; 95% CI: 1.53, 3.17) and preeclampsia (OR: 10.11; 95% CI: 1.83, 55.89). Renal involvement is associated with an increased risk of composite pregnancy outcomes (OR: 3.09; 95% CI: 1.66, 5.72) and preterm birth (OR: 1.65; 95% CI: 1.22, 2.23). Anti-dsDNA is associated with an increased risk of preterm birth (OR: 1.83; 95% CI: 1.13, 2.92) and pregnancy loss (OR: 2.64; 95% CI: 1.09, 6.40). Drug therapy is associated with a decreased risk of composite pregnancy outcomes (OR: 0.51; 95% CI: 0.31, 0.85), preterm birth (OR: 0.66; 95% CI: 0.48, 0.89) and pregnancy loss (OR: 0.42; 95% CI: 0.21, 0.84). Sensitivity analysis demonstrated how solid our results are. Egger's test revealed no discernible publication bias.</p><p><strong>Conclusion: </strong>The onset of SLE, hypertension, renal involvement, drug therapy, and serological factors have a predictive effect on the occurrence of adverse maternal and fetal outcomes in SLE pregnancies. Strengthening preconception risk assessment for SLE patients plays an important role in reducing pregnancy risks and improving the quality of life during pregnancy.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42024564190.</p>\",\"PeriodicalId\":12488,\"journal\":{\"name\":\"Frontiers in Medicine\",\"volume\":\"12 \",\"pages\":\"1573573\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2025-09-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504262/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fmed.2025.1573573\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fmed.2025.1573573","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Risk factors for adverse maternal and fetal outcomes in SLE patients: a systematic review and meta-analysis.
Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that increases the risk of adverse maternal and fetal outcomes in SLE pregnancies. Identifying potential risk factors can enhance preconception risk assessment for SLE pregnancies, thereby reducing the burden of pregnancy for SLE patients.
Objective: The goal of this meta-analysis is to designate the risk factors for unfavorable maternal and fetal outcomes in SLE pregnancies by means of a systematic review of the literature and meta-analysis.
Methods: The odds ratios (ORs) and associated 95% confidence intervals (CIs) were estimated using either a fixed-effects model or a random-effects model. The I2 statistic was used to assess heterogeneity. Sensitivity analysis, Egger's test, the Newcastle-Ottawa Quality Assessment Scale (NOS), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system were also performed.
Results: Eleven papers with 1,790 SLE patients who were pregnant were examined in the meta-analysis out of 2,467 citations that were screened. The meta-analysis's findings indicated that the onset of SLE is associated with an increased risk of preterm birth (OR: 2.85; 95% CI: 2.04, 3.99). Hypertension is associated with an increased risk of composite pregnancy outcomes (OR: 4.56; 95% CI: 2.42, 8.53), preterm birth (OR: 2.20; 95% CI: 1.53, 3.17) and preeclampsia (OR: 10.11; 95% CI: 1.83, 55.89). Renal involvement is associated with an increased risk of composite pregnancy outcomes (OR: 3.09; 95% CI: 1.66, 5.72) and preterm birth (OR: 1.65; 95% CI: 1.22, 2.23). Anti-dsDNA is associated with an increased risk of preterm birth (OR: 1.83; 95% CI: 1.13, 2.92) and pregnancy loss (OR: 2.64; 95% CI: 1.09, 6.40). Drug therapy is associated with a decreased risk of composite pregnancy outcomes (OR: 0.51; 95% CI: 0.31, 0.85), preterm birth (OR: 0.66; 95% CI: 0.48, 0.89) and pregnancy loss (OR: 0.42; 95% CI: 0.21, 0.84). Sensitivity analysis demonstrated how solid our results are. Egger's test revealed no discernible publication bias.
Conclusion: The onset of SLE, hypertension, renal involvement, drug therapy, and serological factors have a predictive effect on the occurrence of adverse maternal and fetal outcomes in SLE pregnancies. Strengthening preconception risk assessment for SLE patients plays an important role in reducing pregnancy risks and improving the quality of life during pregnancy.
期刊介绍：
Frontiers in Medicine publishes rigorously peer-reviewed research linking basic research to clinical practice and patient care, as well as translating scientific advances into new therapies and diagnostic tools. Led by an outstanding Editorial Board of international experts, this multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
In addition to papers that provide a link between basic research and clinical practice, a particular emphasis is given to studies that are directly relevant to patient care. In this spirit, the journal publishes the latest research results and medical knowledge that facilitate the translation of scientific advances into new therapies or diagnostic tools. The full listing of the Specialty Sections represented by Frontiers in Medicine is as listed below. As well as the established medical disciplines, Frontiers in Medicine is launching new sections that together will facilitate
- the use of patient-reported outcomes under real world conditions
- the exploitation of big data and the use of novel information and communication tools in the assessment of new medicines
- the scientific bases for guidelines and decisions from regulatory authorities
- access to medicinal products and medical devices worldwide
- addressing the grand health challenges around the world
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