Related factors of fetal loss in Chinese women with systemic lupus erythematosus: data from Chinese SLE Treatment and Research Group registry IV

Tian, Xinping; Li, Mengtao; Ye, Zhizhong; Zhou, Xiao; Liu, Shengyun; Wu, Lijun; Ma, Li; Bi, Liqi; Zuo, Xiaoxia; Sun, Lingyun; Huang, Cibo; Zhang, Fengchun; Zhao, Yan; Zeng, Xiaofeng

doi:10.1111/1756-185x.12542

Cited by 14 publications

(15 citation statements)

References 23 publications

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“…Published reports on pregnancy outcomes in Chinese women with SLE and lupus nephritis have some limitations. For example, Tian’s research group demonstrated the related factors of fetal loss but not reported the maternal outcomes in Chinese women with SLE[ 23 ]. Liu’s research group demonstrated the adverse outcome between active and inactive SLE pregnancies, however, they didn’t focus on the difference of outcome between pre-existing SLE pregnancies and new-onset SLE during pregnancy, LN pregnancies and non-renal involvement SLE pregnancies[ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE): A Retrospective Study of 109 Pregnancies

Guo

Shi

et al. 2016

PLoS ONE

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Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects women during their reproductive years. The interaction between SLE and pregnancy remains debated. The objective of this study was to analyze the fetal and maternal outcomes of Chinese women with SLE. A total of 109 pregnancies in 83 SLE patients from June 2004 to June 2014 at a tertiary university hospital were reviewed retrospectively. Patients’ characteristics, clinical and laboratory data during pregnancy were obtained from electronic medical records. After exclusion of elective abortions, the live birth rate was 61.5%. Significantly, APS (antiphospholipid syndrome), disease activity, hypertension, hypocomplementemia, thrombocytopenia, and anemia during pregnancy were more commonly observed in fetal loss pregnancies than in live birth pregnancies. Compared to the 64 women with a history of SLE, 19 women with new-onset lupus during pregnancy had worse pregnancy outcome. Furthermore, the 64 patients with a history of SLE were divided into lupus nephritis group and SLE group (non-renal involvement). We found that the lupus nephritis group had worse maternal outcome than the SLE group. We conclude that new-onset lupus during pregnancy predicts both adverse maternal and fetal outcomes, while a history of lupus nephritis predicts adverse maternal outcomes. It is essential to provide SLE women with progestational counseling and regular multispecialty care during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE): A Retrospective Study of 109 Pregnancies

Guo

Shi

et al. 2016

PLoS ONE

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“…Risk factors of pregnant loss in women with SLE include active SLE, new onset SLE during pregnancy, aPLs, hypocomlementemia, anti-dsDNA antibodies, thrombocytopenia, hypertension and lupus nephritis [ 1 , 2 , 8 , 9 , 10 , 11 , 12 ]. A new study based on 992 SLE patients with 2026 pregnancies suggested that thrombocytopenia, aPL antibodies and anti-SSA antibody are associated with fetal loss in Chinese women [ 19 ]. Although women with SLE have an increased risk of adverse outcomes, patients in remission or stable mild/moderate SLE might have favorable outcomes [ 1 , 2 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy in Women with Systemic Lupus Erythematosus: A Retrospective Study of 83 Pregnancies at a Single Centre

Chen

Sun

et al. 2015

IJERPH

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Objective: To evaluate the outcome of 80 pregnant women with systemic lupus erythematosus (SLE) and explore the risk factors for lupus flare, obstetric complications and fetal loss. Methods: 83 pregnancies in 80 women were divided into three groups. Group A: patients in remission for > 6 months before pregnancy, proteinuria < 0.5 g per day, without renal failure and discontinuation of cytotoxic drugs for > one year; Group B: patients with SLE disease activity in the six months before pregnancy; Group C: patients with new onset SLE during pregnancy. Results: In group A, 76.47% pregnancies achieved full-term deliveries and 80.39% achieved live born infants. In group B and C, the outcome was poor. Among 62 patients (64 pregnancies) diagnosed as SLE before pregnancy, SLE flares occurred in 27 (42.19%) pregnancies. SLE disease activity in the six months before pregnancy was significantly associated with lupus flare (OR 5.00, 95% CI 1.14–21.87, p = 0.03) and fetal loss. New onset lupus during pregnancy was independently associated with obstetric complications (OR 7.22, 95% CI 2.14–24.38, p = 0.001). Conclusions: The current study confirmed the previous report that SLE should be considered a high risk of pregnancy. If pregnancy is planned after remission for > 6 months, the favorable outcome can be achieved.

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“…Advice about safety and timing of conception requires identification of clinical and laboratory variables that predict fetal loss and other adverse pregnancy outcomes 4. While numerous studies have identified risk factors for fetal loss in pregnant women with SLE, such as lupus nephritis,5–7 SLE activity during 6 months before pregnancy,8 low complement levels,9 antiphospholipid syndrome, anti-SSA/Ro antibodies, thrombocytopenia10 and many other factors have been introduced in previous studies,11–17 results varied among studies. The numerous risk factors and the complicated relationships among these factors necessitate the development of a clinical prediction model.…”

Section: Introductionmentioning

confidence: 99%

Prediction of fetal loss in Chinese pregnant patients with systemic lupus erythematosus: a retrospective cohort study

Zhang

et al. 2019

BMJ Open

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ObjectiveTo develop a predictive model for fetal loss in women with systemic lupus erythematosus (SLE).DesignA retrospective cohort study.SettingData were collected in a tertiary medical centre, located in Shanghai, China, from September 2011 to May 2017.Participants338 pregnancies with SLE were analysed retrospectively. Cases of multiple pregnancy and those in which artificial abortion was performed for personal reasons were excluded.Primary outcome measuresFetal loss was the primary outcome. A stepwise regression to identify the predictors related to the fetal loss and coefficient B of each variable was used to develop a predictive model and make a corresponding risk classification. The Hosmer-Lemeshow test, Omnibus test and area under the receiver-operating characteristic curve (AUC) were used to assess the goodness-of-fit and discrimination of the predictive model. A 10-fold cross validation was used to assess the model for overfitting.ResultsUnplanned pregnancies (OR 2.84, 95% CI 1.12 to 7.22), C3 hypocomplementemia (OR 5.46, 95% CI 2.30 to 12.97) and 24 hour-urinary protein level (0.3≤protein<1.0 g/24 hours: OR 2.10, 95% CI 0.63 to 6.95; protein≥1.0 g/24 hours: OR 5.89, 95% CI 2.30 to 15.06) were selected by the stepwise regression. The Hosmer-Lemeshow test resulted in p=0.325; the Omnibus test resulted in p<0.001 and the AUC was 0.829 (95% CI 0.744 to 0.91) in the regression model. The corresponding risk score classification was divided into low risk (0–3) and high risk groups (>3), with a sensitivity of 60.5%, a specificity of 93.3%, positive likelihood ratio of 9.03 and negative likelihood ratio of 0.42.ConclusionsA predictive model for fetal loss in women with SLE was developed using the timing of conception, C3 complement and 24 hour-urinary protein level. This model may help clinicians in identifying women with high risk pregnancies, thereby carrying out monitoring or/and interventions for improving fetal outcomes.

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Related factors of fetal loss in Chinese women with systemic lupus erythematosus: data from Chinese SLE Treatment and Research Group registry IV

Abstract: Both univariate analysis and binary logistic regression analysis suggest that thrombocytopenia, aPL antibodies and anti-SSA antibody are associated with fetal loss in Chinese SLE women, while arthritis may be a possible factor related to favorable pregnancy outcome.

Cited by 14 publications

References 23 publications

Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE): A Retrospective Study of 109 Pregnancies

Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE): A Retrospective Study of 109 Pregnancies

Pregnancy in Women with Systemic Lupus Erythematosus: A Retrospective Study of 83 Pregnancies at a Single Centre

Prediction of fetal loss in Chinese pregnant patients with systemic lupus erythematosus: a retrospective cohort study

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