Dongying Chen1, Minxi Lao1,2, Xiaoyan Cai3, Hao Li1, Yanfeng Zhan4, Xiaodong Wang5, Zhongping Zhan6. 1. Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, No 58, Zhongshan 2nd Road, Guangzhou, 510080, China. 2. Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 3. Department of Rheumatology, Guangzhou First People's Hospital, Guangzhou, China. 4. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 5. Department of Ultrasound, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No 16, Jichang Road, Guangzhou, 510405, China. 9160240@qq.com. 6. Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, No 58, Zhongshan 2nd Road, Guangzhou, 510080, China. zhanchuyue@163.com.
Abstract
BACKGROUND: Hypertension disorders in pregnancy (HDP) were common complications in women with systemic lupus erythematosus (SLE). However, the impact of HDP and the measures to prevent HDP-related fetal adverse pregnancy outcomes (APOs) remained to be explored. METHODS: A multicenter retrospective study of 342 pregnant women with SLE was performed. Variables related to SLE and APOs were recorded. Fetal development was evaluated by umbilical artery Doppler ultrasonography. RESULTS: HDP was diagnosed in 45 (13.2%) patients, including pre-eclampsia in 42 and gestational hypertension in 3. Patients with HDP had higher incidence of preterm birth (71.1% vs 20.9%, P < 0.001), intrauterine growth retardation (IUGR) (37.8% vs 11.8%, P < 0.001), low-birth-weight infants (62.2% vs 17.2%, P < 0.001), and very-low-birth-weight infants (37.8% vs 2.7%, P < 0.001), compared with lupus patients without HDP. A total of 35 (77.8%) HDP patients had disease activation during pregnancy. All the events occurred during the second and third trimesters, mainly presenting as moderate-to-high activity (65.7%). Active disease [odds ratios (OR) = 3.9, 95% confidential interval (CI) 1.5-9.7, P = 0.004] and positive anticardiolipin (aCL) antibody (OR = 7.6, 95% CI 2.7-18.6, P < 0.001) were independent risk factors for HDP in lupus patients. Doppler RI and S/D ratio predicted APOs in patients with HDP. The optimal cut-off values for RI and S/D ratio were 0.7 (sensitivity 48.1%, specificity 53.3%) and 3.4 (sensitivity 66.7%, specificity 100%), respectively. CONCLUSIONS: HDP was a common pregnant complication and caused various fetal and maternal adverse outcomes in patients with SLE. Umbilical artery Doppler ultrasonography was effective in predicting fetal APOs in lupus patients with HDP.Key Points• HDP induced preterm birth, IUGR, low-birth-weight infants, and very-low-birth-weight infants in patients with SLE.• HDP led to lupus activation during the second and third trimesters.• Disease activation and aCL positivity were predictors for HDP.• RI and S/D ratio from umbilical artery Doppler predicted APOs in patients with HDP.
BACKGROUND:Hypertension disorders in pregnancy (HDP) were common complications in women with systemic lupus erythematosus (SLE). However, the impact of HDP and the measures to prevent HDP-related fetal adverse pregnancy outcomes (APOs) remained to be explored. METHODS: A multicenter retrospective study of 342 pregnant women with SLE was performed. Variables related to SLE and APOs were recorded. Fetal development was evaluated by umbilical artery Doppler ultrasonography. RESULTS: HDP was diagnosed in 45 (13.2%) patients, including pre-eclampsia in 42 and gestational hypertension in 3. Patients with HDP had higher incidence of preterm birth (71.1% vs 20.9%, P < 0.001), intrauterine growth retardation (IUGR) (37.8% vs 11.8%, P < 0.001), low-birth-weight infants (62.2% vs 17.2%, P < 0.001), and very-low-birth-weight infants (37.8% vs 2.7%, P < 0.001), compared with lupuspatients without HDP. A total of 35 (77.8%) HDP patients had disease activation during pregnancy. All the events occurred during the second and third trimesters, mainly presenting as moderate-to-high activity (65.7%). Active disease [odds ratios (OR) = 3.9, 95% confidential interval (CI) 1.5-9.7, P = 0.004] and positive anticardiolipin (aCL) antibody (OR = 7.6, 95% CI 2.7-18.6, P < 0.001) were independent risk factors for HDP in lupuspatients. Doppler RI and S/D ratio predicted APOs in patients with HDP. The optimal cut-off values for RI and S/D ratio were 0.7 (sensitivity 48.1%, specificity 53.3%) and 3.4 (sensitivity 66.7%, specificity 100%), respectively. CONCLUSIONS: HDP was a common pregnant complication and caused various fetal and maternal adverse outcomes in patients with SLE. Umbilical artery Doppler ultrasonography was effective in predicting fetal APOs in lupuspatients with HDP.Key Points• HDP induced preterm birth, IUGR, low-birth-weight infants, and very-low-birth-weight infants in patients with SLE.• HDP led to lupus activation during the second and third trimesters.• Disease activation and aCL positivity were predictors for HDP.• RI and S/D ratio from umbilical artery Doppler predicted APOs in patients with HDP.
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