Arthritis & R:系统性硬化症女性患者早产风险增高
来源:爱唯医学网 2012-11-18 10:45
近日,据发表于Arthritis & Rheumatism杂志的一项研究"Successful pregnancies but a higher risk of preterm births in systemic sclerosis: An Italian multicentric study"结果表明,很多系统性硬化症女性患者可以成功妊娠...
近日,据发表于Arthritis & Rheumatism杂志的一项研究"Successful pregnancies but a higher risk of preterm births in systemic sclerosis: An Italian multicentric study"结果表明,很多系统性硬化症女性患者可以成功妊娠,但其早产、低出生体重和宫内生长受限的发生率几乎为一般人群中妊娠妇女的2倍。
之前研究的数据提示,系统性硬化症(SSc)妇女妊娠的结局与一般人群相同,但这些研究均为小型病例系列或大型数据库回顾,无法确定具体患者。在这项前瞻性研究中,意大利布雷西亚Spedali Civili和大学的Mara Taraborelli博士及其同事于2000~2011年间对99例SSc女患者进行了追踪,这些患者在此期间共发生109次妊娠,且均在意大利的25个研究中心之一就诊。患者妊娠时的平均年龄为32岁,多为白人,其中107例妊娠是自然妊娠,2例妊娠是通过辅助生殖技术达成的。
结果显示,与作为对照的一般产科人群相比,SSc妇女中早产更为常见(发生率分别为12%和25%)。SSc妇女中的重度早产(定义为妊娠不足34周时分娩)发生率也显著高于对照人群(分别为10%和5%)。此外,SSc妇女中分娩极低出生体重儿和宫内生长受限病例的发生率也显著高于对照人群(分别为5% vs. 1%和6% vs. 1%)。但SSc妇女中妊娠高血压疾病或自然流产的发生率并不高于一般的妊娠人群。“有很低比例的患者在妊娠结束后很短的时间内发生疾病进展;在近期发病的aSCL-70阳性患者中,这种风险可能更高”。所有4例在分娩后12个月内发生内脏疾病进展的患者均为aSCL-70阳性,并且23例aSCL-70阳性且病程不足3年的患者中有3例(13%)在分娩后发生某种程度的疾病进展。共有6例新生儿入住重症监护室,中位收住时间为15天。其中,有1例新生儿为重度早产,并死于多器官衰竭。
研究者总结认为,尽管母儿预后较差,但在多学科管理下,SSc妇女可能成功妊娠。然而,对于有重度器官损害或近期发病的SSc妇女,尤其是抗拓扑异构酶阳性的患者,不建议妊娠。
研究者披露无相关利益冲突。该研究部分由3个患者协会组织资助,分别为:Gruppo Italiano Lotta alla Sclerodermia、Gruppo Lupus Eritematoso Sistemico Lombardia和Associazone Lombarda Malati Reumatici。(生物谷bioon.com)
Successful pregnancies but a higher risk of preterm births in systemic sclerosis: An Italian multicentric study
Mara Taraborelli MD1, Véronique Ramoni MD2,3, Antonio Brucato MD3,*, Paolo Airò MD1, Gianluigi Bajocchi MD4, Francesca Bellisai MD5, Domenico Biasi MD6, et al.
Objective.
To assess fetal and maternal outcomes in women with systemic sclerosis (SSc).
Methods.
Prospectively collected data were retrospectively analyzed. In 25 Italian centers 99 SSc women were observed during 109 pregnancies (in 2000-2011) and compared to the general obstetrical population (GOP, 3939 deliveries). Maternal mean age at conception was 31.8 years (SD 5.3) and median disease duration was 60 months (range 2-193).
Results.
In SSc patients preterm deliveries (25% vs. 12%) and severe preterm deliveries (<34 weeks) (10% vs. 5%), intrauterine growth restriction (6% vs. 1%) and very-low-birth-weight babies (5% vs. 1%) were significantly more frequent than in the GOP. Multivariable analysis found that corticosteroid use was associated with preterm deliveries (OR 3.63, 95% CI 1.12-11.78), while the use of folic acid was protective (OR 0.30, 95% CI 0.10-0.91), as were antitopoisomerase antibodies (OR 0.26, 95% CI 0.08-0.85). The disease remained stable in most SSc patients, but there were four cases of progression within one year from delivery, all in antitopoisomerase-positive women, three of them with less than three years' disease duration.
Conclusions.
SSc patients can have successful pregnancies, but they have a higher than normal risk of preterm delivery, intrauterine growth restriction and very-low-birth-weight babies. Progression of the disease during or after pregnancy is rare but possible. High-risk multidisciplinary management should be standard for these patients and pregnancy should be avoided in cases with severe organ damage and postponed in women with SSc of recent onset, particularly if antitopoisomerase positive.
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