{"title":"Sjögren综合征与妊娠:一项葡萄牙病例对照研究。","authors":"Tânia Barros, Jorge Braga, Maria Inês Abreu, Mariana Brandão, Fátima Farinha, António Marinho, António Braga","doi":"10.5114/reum.2022.120754","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Pregnancy in patients with autoimmune disorders is associated with an increased risk of adverse outcomes. Sjögren's syndrome (SS) is one of the most common among autoimmune diseases. Presently data regarding the impact of SS on obstetric outcomes are scarce and inconclusive. This study aims to evaluate the impact of SS on maternal-fetal and neonatal outcomes compared with pregnancy outcomes in the general population.</p><p><strong>Material and methods: </strong>A retrospective case-control study included 26 pregnancies in SS patients and a healthy control group (CG), followed in a Portuguese tertiary center, between 2015 and 2020. Baseline maternal data were collected, and maternal-fetal and neonatal outcomes were evaluated. Statistical analysis used SPSS 25.0, and a <i>p</i>-value of 0.05 was considered statistically significant.</p><p><strong>Results: </strong>All pregnancies occurred after the diagnosis of SS, with a mean exposure time between diagnosis and pregnancy of 4.92 ±2.78 years. In the SS group, the incidence of ANA, anti-Ro/SSA, and anti-La/SSB antibodies positivity was 80.8%, 61.5%, and 46.2%, respectively. Hydroxychloroquine (HCQ) was used in 57.7%.Miscarriage was significantly higher in the SS group (19.2% vs. 1.8%, <i>p</i> < 0.01). There was a higher prevalence of fetal growth restriction (OR 11.16, 95% CI: 0.96-129.26). Preterm delivery (9.5% vs. 5.6%, <i>p</i> = 0.503) and mean birth weight (2998.16 g vs. 3155.79 g, <i>p</i> = 0.178) did not differ significantly between the groups. In the SS group, admission to the neonatal intensive care unit (NICU) rate was increased (OR 71.67, 95% CI: 3.78-1357.16). Three pregnancies were complicated by congenital heart block (CHB) (14.3% vs. 0%, <i>p</i> = 0.015). In all cases, the diagnosis was performed during second trimester of pregnancy, and betamethasone was administered.</p><p><strong>Conclusions: </strong>Women with SS had a significantly higher incidence of miscarriage, admission to NICU, and CHB than controls. Congenital heart block was the most critical condition that affects the offspring of mothers with SS. Successful pregnancy in the study group was possible with prenatal monitoring and a multidisciplinary approach.</p>","PeriodicalId":21312,"journal":{"name":"Reumatologia","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/01/5b/RU-60-48070.PMC9661414.pdf","citationCount":"1","resultStr":"{\"title\":\"Sjögren's syndrome and pregnancy: a Portuguese case-control study.\",\"authors\":\"Tânia Barros, Jorge Braga, Maria Inês Abreu, Mariana Brandão, Fátima Farinha, António Marinho, António Braga\",\"doi\":\"10.5114/reum.2022.120754\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Pregnancy in patients with autoimmune disorders is associated with an increased risk of adverse outcomes. Sjögren's syndrome (SS) is one of the most common among autoimmune diseases. Presently data regarding the impact of SS on obstetric outcomes are scarce and inconclusive. This study aims to evaluate the impact of SS on maternal-fetal and neonatal outcomes compared with pregnancy outcomes in the general population.</p><p><strong>Material and methods: </strong>A retrospective case-control study included 26 pregnancies in SS patients and a healthy control group (CG), followed in a Portuguese tertiary center, between 2015 and 2020. Baseline maternal data were collected, and maternal-fetal and neonatal outcomes were evaluated. Statistical analysis used SPSS 25.0, and a <i>p</i>-value of 0.05 was considered statistically significant.</p><p><strong>Results: </strong>All pregnancies occurred after the diagnosis of SS, with a mean exposure time between diagnosis and pregnancy of 4.92 ±2.78 years. In the SS group, the incidence of ANA, anti-Ro/SSA, and anti-La/SSB antibodies positivity was 80.8%, 61.5%, and 46.2%, respectively. Hydroxychloroquine (HCQ) was used in 57.7%.Miscarriage was significantly higher in the SS group (19.2% vs. 1.8%, <i>p</i> < 0.01). There was a higher prevalence of fetal growth restriction (OR 11.16, 95% CI: 0.96-129.26). Preterm delivery (9.5% vs. 5.6%, <i>p</i> = 0.503) and mean birth weight (2998.16 g vs. 3155.79 g, <i>p</i> = 0.178) did not differ significantly between the groups. In the SS group, admission to the neonatal intensive care unit (NICU) rate was increased (OR 71.67, 95% CI: 3.78-1357.16). Three pregnancies were complicated by congenital heart block (CHB) (14.3% vs. 0%, <i>p</i> = 0.015). In all cases, the diagnosis was performed during second trimester of pregnancy, and betamethasone was administered.</p><p><strong>Conclusions: </strong>Women with SS had a significantly higher incidence of miscarriage, admission to NICU, and CHB than controls. Congenital heart block was the most critical condition that affects the offspring of mothers with SS. Successful pregnancy in the study group was possible with prenatal monitoring and a multidisciplinary approach.</p>\",\"PeriodicalId\":21312,\"journal\":{\"name\":\"Reumatologia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/01/5b/RU-60-48070.PMC9661414.pdf\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Reumatologia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5114/reum.2022.120754\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/11/4 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reumatologia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5114/reum.2022.120754","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/11/4 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 1
摘要
自身免疫性疾病患者的妊娠与不良结局的风险增加相关。Sjögren综合征(SS)是最常见的自身免疫性疾病之一。目前,关于SS对产科结果影响的数据很少且不确定。本研究旨在评估SS对母胎和新生儿结局的影响,并将其与普通人群的妊娠结局进行比较。材料和方法:一项回顾性病例对照研究,包括2015年至2020年在葡萄牙三级中心随访的26例妊娠SS患者和健康对照组(CG)。收集基线产妇数据,评估母胎和新生儿结局。统计学分析采用SPSS 25.0, p值为0.05认为有统计学意义。结果:所有妊娠均发生在SS诊断后,从诊断到妊娠平均暴露时间为4.92±2.78年。SS组ANA阳性率为80.8%,抗ro /SSA阳性率为61.5%,抗la /SSB阳性率为46.2%。羟氯喹(HCQ)占57.7%。SS组流产率明显高于对照组(19.2% vs. 1.8%, p < 0.01)。胎儿生长受限的患病率较高(OR 11.16, 95% CI: 0.96-129.26)。早产(9.5% vs. 5.6%, p = 0.503)和平均出生体重(2998.16 g vs. 3155.79 g, p = 0.178)组间无显著差异。SS组新生儿重症监护病房(NICU)入院率增加(OR 71.67, 95% CI: 3.78 ~ 1357.16)。3例妊娠合并先天性心脏传导阻滞(CHB) (14.3% vs. 0%, p = 0.015)。在所有病例中,诊断是在妊娠中期进行的,并给予倍他米松。结论:SS患者流产、入住NICU和CHB的发生率明显高于对照组。先天性心脏传导阻滞是影响SS母亲后代的最关键条件。通过产前监测和多学科方法,研究组的成功妊娠是可能的。
Sjögren's syndrome and pregnancy: a Portuguese case-control study.
Introduction: Pregnancy in patients with autoimmune disorders is associated with an increased risk of adverse outcomes. Sjögren's syndrome (SS) is one of the most common among autoimmune diseases. Presently data regarding the impact of SS on obstetric outcomes are scarce and inconclusive. This study aims to evaluate the impact of SS on maternal-fetal and neonatal outcomes compared with pregnancy outcomes in the general population.
Material and methods: A retrospective case-control study included 26 pregnancies in SS patients and a healthy control group (CG), followed in a Portuguese tertiary center, between 2015 and 2020. Baseline maternal data were collected, and maternal-fetal and neonatal outcomes were evaluated. Statistical analysis used SPSS 25.0, and a p-value of 0.05 was considered statistically significant.
Results: All pregnancies occurred after the diagnosis of SS, with a mean exposure time between diagnosis and pregnancy of 4.92 ±2.78 years. In the SS group, the incidence of ANA, anti-Ro/SSA, and anti-La/SSB antibodies positivity was 80.8%, 61.5%, and 46.2%, respectively. Hydroxychloroquine (HCQ) was used in 57.7%.Miscarriage was significantly higher in the SS group (19.2% vs. 1.8%, p < 0.01). There was a higher prevalence of fetal growth restriction (OR 11.16, 95% CI: 0.96-129.26). Preterm delivery (9.5% vs. 5.6%, p = 0.503) and mean birth weight (2998.16 g vs. 3155.79 g, p = 0.178) did not differ significantly between the groups. In the SS group, admission to the neonatal intensive care unit (NICU) rate was increased (OR 71.67, 95% CI: 3.78-1357.16). Three pregnancies were complicated by congenital heart block (CHB) (14.3% vs. 0%, p = 0.015). In all cases, the diagnosis was performed during second trimester of pregnancy, and betamethasone was administered.
Conclusions: Women with SS had a significantly higher incidence of miscarriage, admission to NICU, and CHB than controls. Congenital heart block was the most critical condition that affects the offspring of mothers with SS. Successful pregnancy in the study group was possible with prenatal monitoring and a multidisciplinary approach.