Arterial/venous thrombosis, fetal loss and stillbirth in pregnant women with systemic lupus erythematosus versus primary and secondary antiphospholipid syndrome: a systematic review and meta-analysis

Bundhun, Pravesh Kumar; Soogund, Mohammad Zafooruddin Sani; Huang, Feng

doi:10.1186/s12884-018-1850-x

Cited by 22 publications

(22 citation statements)

References 36 publications

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“…aPL are associated with thrombosis and pregnancy morbidities, both in primary APS and the APS associated with other autoimmune diseases, including SLE. 33 There are other manifestations, not included in the Sidney classification criteria, 19 that have also been associated with aPL. Consistent with previous studies, 25,28,30,31,34–36 we found that SLE-aPL patients had higher rates of thrombocytopenia than those with SLE.…”

Section: Discussionmentioning

confidence: 99%

Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality

Riancho‐Zarrabeitia

Martínez‐Taboada

Rúa-Figueroa

et al. 2020

Lupus

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Introduction Antiphospholipid antibodies (aPL) have been associated with organ damage and certain features in systemic lupus erythematosus(SLE) patients. Our aim was to investigate the differences between SLE patients according to the presence of aPL and/or clinical antiphospholipid syndrome (APS). Materials and methods Patients from the RELESSER-T registry were included. RELESSER-T is a Spanish multicenter, hospital-based, retrospective, SLE registry. Results We included 2398 SLE patients, 1372 of whom were positive for aPL. Overall 1026 patients were classified as SLE, 555 as SLE-APS and817 as SLE-aPL. Regarding cardiovascular risk factors, SLE-APS patients had higher rates of hypertension, dyslipidemia and diabetes than those with SLE-aPL and SLE ( p < 0.001). SLE-APS patients showed higher rates of neuropsychiatric, cardiac, pulmonary, renal and ophthalmological manifestations than the other groups ( p < 0.001). SLE-APS patients presented greater damage accrual with higher SLICC values (1.9 ± 2.2 in SLE-APS, 0.9 ± 1.4 in SLE-aPL and 1.1 ± 1.6 in SLE, p < 0.001) and more severe disease as defined by the Katz index (3 ± 1.8 in SLE-APS, 2.7 ± 1.7 in SLE-aPL and 2.6 ± 1.6 in SLE, p < 0.001). SLE-APS patients showed higher mortality rates ( p < 0.001). Conclusions SLE-APS patients exhibited more severe clinical profiles with higher frequencies of major organ involvement, greater damage accrual and higher mortality than SLE-aPL and SLE patients.

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Section: Discussionmentioning

confidence: 99%

Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality

Riancho‐Zarrabeitia

Martínez‐Taboada

Rúa-Figueroa

et al. 2020

Lupus

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“…Another meta-analysis has even compared pregnant women with SLE vs those with APS. [4] However, previous studies did not systematically focus specifically on the impact of APS on pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in patients with primary antiphospholipid syndrome

Liu

Sun

2019

Medicine

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Background: Antiphospholipid syndrome (APS) is a rare heterogenous autoimmune disorder with severe life-threatening complications shown during pregnancy. In this analysis, we aimed to systematically compare the pregnancy outcomes (both maternal and fetal) in patients with APS. Methods: Web of Science, Google Scholar, Medicus, Cochrane Central, Embase, and Medline were searched for relevant English publications. The main inclusion criteria were based on studies that compared pregnancy outcomes in patients with APS vs a control group. Statistical analysis was carried out by the RevMan software version 5.3. This analysis involved dichotomous data, and risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the analysis. Results: Eight studies consisting of a total number of 212,954 participants were included. Seven hundred seventy participants were pregnant women with APS and 212,184 participants were assigned to the control group. Pregnancy-induced hypertension was significantly higher in women with APS (RR: 1.81, 95% CI: 1.33 – 2.45; P = .0002). The risks of fetal loss (RR: 1.33, 95% CI: 1.00–1.76; P = .05), abortion (RR: 2.42, 95% CI: 1.46–4.01; P = .0006), thrombosis (RR: 2.83, 95% CI: 1.47–5.44; P = .002), and preterm delivery (RR: 1.89, 95% CI: 1.52–2.35; P = .00001) were also significantly higher in women with APS. However, placental abruption (RR: 1.35, 95% CI: 0.78–2.34; P = .29) and pulmonary embolism were not significantly different (RR: 1.47, 95% CI: 0.11–19.20; P = .77). The risk of neonatal mortality (RR: 3.95, 95% CI: 1.98–7.86; P = .0001), infants small for gestational age (RR: 1.38, 95% CI: 1.04–1.82; P = .02), premature infants (RR: 1.86, 95% CI: 1.52–2.28; P = .0001), and infants who were admitted to neonatal intensive care unit (RR: 3.35, 95% CI: 2.29–4.89; P = .00001) were also significantly higher in women with APS. Conclusion: This analysis showed APS to be associated with significantly worse pregnancy outcomes when compared to the control group. A significantly higher risk of maternal and fetal complications was observed in this category of patients. Therefore, intense care should be given to pregnant women with APS to monitor unwanted outcomes and allow a successful pregnancy.

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“…Furthermore, risk of foetal loss with APS has been widely reported in literature [ 28 , 34 ]. A systematic revision with meta-analysis compared foetal loss in 556 pregnant women with SLE versus 385 women with APS; without the appropriate treatment, the group with APS presented a higher risk of foetal loss (RR: 4.49; 95%CI: 2.1–9.6; p = 0.0001) [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Unit Improves Pregnancy Outcomes in Women with Rheumatic Diseases and Hereditary Thrombophilias: An Observational Study

Añón-Oñate¹,

Cáliz-Cáliz

Rosa-Garrido³

et al. 2021

JCM

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Rheumatic diseases (RD) and hereditary thrombophilias (HT) can be associated with high-risk pregnancies. This study describes obstetric outcomes after receiving medical care at a multidisciplinary consultation (MC) and compares adverse neonatal outcomes (ANOs) before and after medical care at an MC. This study is a retrospective observational study among pregnant women with RD and HT treated at an MC of a university hospital (southern Spain) from 2012 to 2018. Absolute risk reduction (ARR) and number needed to treat (NNT) were calculated. A total of 198 pregnancies were registered in 143 women (112 with RD, 31 with HT), with 191 (96.5%) pregnancies without ANOs and seven (3.5%) pregnancies with some ANOs (five miscarriages and two foetal deaths). Results previous to the MC showed 60.8% of women had more than one miscarriage, with 4.2% experiencing foetal death. MC reduced the ANO rate by AAR = 60.1% (95%CI: 51.6−68.7%). The NNT to avoid one miscarriage was 1.74 (95%CI: 1.5–2.1) and to avoid one foetal death NNT = 35.75 (95CI%: 15.2–90.9). A total of 84.8% of newborns and 93.2% of women did not experience any complication. As a conclusion, the follow-up of RD or HT pregnant women in the MC drastically reduced the risk of ANOs in this population with a previous high risk.

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Arterial/venous thrombosis, fetal loss and stillbirth in pregnant women with systemic lupus erythematosus versus primary and secondary antiphospholipid syndrome: a systematic review and meta-analysis

Cited by 22 publications

References 36 publications

Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality

Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality

Pregnancy outcomes in patients with primary antiphospholipid syndrome

Multidisciplinary Unit Improves Pregnancy Outcomes in Women with Rheumatic Diseases and Hereditary Thrombophilias: An Observational Study

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