Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia

Autor: Ruslinda Mustafar, Rozita Mohd, Rahana Abdul Rahman, Rizna Abdul Cader, Syahrul Sazliyana Shaharir, Mohd Shahrir Mohamed Said
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Maternal Health
Miscarriage
Pathology and Laboratory Medicine
0302 clinical medicine
Pregnancy
Recurrence
Risk Factors
Ethnicity
Medicine and Health Sciences
Lupus Erythematosus
Systemic
Ethnicities
Outpatient clinic
030212 general & internal medicine
Prospective cohort study
skin and connective tissue diseases
Univariate analysis
Multidisciplinary
Obstetrics
Postpartum Period
Malay People
Obstetrics and Gynecology
Hematology
Lupus Nephritis
Proteinuria
Cohort
Medicine
Female
Research Article
Adult
medicine.medical_specialty
Science
Immunology
Systemic Lupus Erythematosus
Autoimmune Diseases
03 medical and health sciences
Signs and Symptoms
Rheumatology
Diagnostic Medicine
medicine
Humans
Retrospective Studies
030203 arthritis & rheumatology
Lupus Erythematosus
business.industry
Malaysia
Biology and Life Sciences
Retrospective cohort study
medicine.disease
Pregnancy Complications
People and Places
Women's Health
Clinical Immunology
Population Groupings
Clinical Medicine
business
Chinese People
Postpartum period
Zdroj: PLoS ONE, Vol 14, Iss 9, p e0222343 (2019)
PLoS ONE
ISSN: 1932-6203
Popis: Flare of Systemic Lupus Erythematosus (SLE) may occur during pregnancy and puerperium. We studied the prevalence and factors associated with SLE relapse during pregnancy and post-partum period in a multi-ethnic SLE cohort. Consecutive SLE patients who attended the outpatient clinic were reviewed for previous history of pregnancies in our institution. Patients who had a complete antenatal, delivery, and post-partum follow up were included. Their medical records were retrospectively analysed to assess the disease activity at pre-pregnancy/conception, during antenatal, and post-partum period. Presence of flare episodes during pregnancy and puerperium were recorded. The pregnancy outcomes recorded include live birth, foetal loss, prematurity and intra-uterine growth restrictions (IUGR). Univariate and multivariable logistic regression with generalized estimating equations (GEE) analyses were performed to determine the factors associated with disease relapse and the pregnancy outcomes. A total of 120 patients with 196 pregnancies were included, with a live birth rate of 78.6%. Four (2.0%) were diagnosed to have SLE during pregnancy. The flare rate in pregnancy was 40.1% while post-partum 17.4%. Majority of the relapse in pregnancy occurred in haematological system (62.3%) followed by renal (53.2%), musculoskeletal (22.1%), and mucocutaneous (14.3%). In GEE analyses, active disease at conception was the independent predictor of SLE relapse during and after pregnancy, whereas older maternal age and Malay ethnicity were associated with higher flare during post-partum. HCQ use was significantly associated with reduced risk of flare in univariate analysis but it was no longer significant in the GEE analyses. Presence of disease flare in pregnancy was significantly associated with prematurity. In conclusion, pregnancy in SLE need to be planned during quiescent state as pre-pregnant active disease was associated with disease relapse in both during and after pregnancy. Malay patients had an increased risk of post-partum flare but further larger prospective studies are needed to confirm the association between pregnancies in the different ancestral background.
Databáze: OpenAIRE
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