Maternal and fetal outcomes in those with autoimmune connective tissue disease.

Autor: Alrifai N; Department of Rheumatology, Cooper University, Camden, NJ, USA., Puttur A; Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA., Ghanem F; Department of Cardiovascular Disease, Southern Illinois University, Springfield, IL, USA., Dhital Y; Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA., Jabri A; Department of Cardiovascular Disease, Henry Ford, Detroit, MI, USA., Al-Abdouh A; Department of Medicine, University of Kentucky, Lexington, KY, USA., Alhuneafat L; Division of Cardiology, University of Minnesota, Minneapolis, USA. Alhun005@umn.edu.; Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, USA. Alhun005@umn.edu.
Jazyk: angličtina
Zdroj: Clinical rheumatology [Clin Rheumatol] 2024 Nov 30. Date of Electronic Publication: 2024 Nov 30.
DOI: 10.1007/s10067-024-07242-6
Abstrakt: Introduction: Autoimmune CTDs like systematic lupus erythematosus (SLE), systemic sclerosis (SSc), and rheumatoid arthritis (RA)predominantly affect women during reproductive years and are linked to maternal and fetal complications.
Methods: We conducted a population-based, retrospective cohort study using the national inpatient data sample to compare maternal and fetal outcomes in patients with and without CTD delivering between October 2015 and December 2020. Regression analysis was performed and adjusted for multiple patient characteristics to compare outcomes.
Results: Our study comprised of 18,866,050 deliveries, of which 50,450 (0.02%) had autoimmune CTD, including 25,340 with SLE, 23,945 with RA, and 1,165 with SSc. Patients with CTDs had significantly higher odds of maternal death (aOR 3.898; 95% CI: 1.462-10.389, p = 0.007), hypertensive disorders (aOR 1.554; 95% CI: 1.456-1.659, p < 0.001), acute kidney injury (aOR 4.886; 95% CI: 3.934-6.069, p < 0.001), blood transfusions (aOR 1.853; 95% CI: 1.628-2.109, p < 0.001), peripartum cardiomyopathy (aOR 2.709; 95% CI: 1.492-4.917, p = 0.001), sepsis (aOR 2.112; 95% CI: 1.430-3.119, p < 0.001), and ARDS (aOR 1.623; 95% CI: 1.076-2.449, p = 0.021). Fetal outcomes were also worse, with higher odds of small for gestational age fetuses (aOR 1.926; 95% CI: 1.779-2.086, p < 0.001), stillbirth (aOR 1.644; 95% CI: 1.352-2.000, p < 0.001), and preterm labor (aOR 1.702; 95% CI: 1.574-1.841, p < 0.001). Patients with RA, SS, and SLE experience varying degrees of complications.
Conclusion: Our study shows that pregnant patients with autoimmune CTDs have worse maternal and fetal outcomes compared to those without CTDs. The rates of adverse outcomes varies among CTD subtypes. Comprehensive preconception counseling and tailored management strategies are essential for optimizing outcomes in these patients. Key Points • Increased Maternal Complications: Patients with autoimmune CTDs had significantly higher odds of maternal death, hypertensive disorders, acute kidney injury, blood transfusions, peripartum cardiomyopathy, sepsis, and ARDS. • Adverse Fetal Outcomes: Higher odds of small for gestational age fetuses, stillbirth, and preterm labor were observed in patients with CTDs compared to those without. • CTD Subtype Variations: Complication rates varied among CTD subtypes, with SLE, RA, and SSc each presenting varying risks and outcomes.
Competing Interests: Declarations. All authors have approved this manuscript and this submission. Ethical compliance: The research qualifies as no risk or minimal risk to subjects and our institution does not require ethical approval for NIS database studies. Conflicts of interest: The authors do not have any conflicts of interest to disclose.
(© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)
Databáze: MEDLINE
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