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

机译:马来西亚多种族患者怀孕妊娠与妊娠的预测因素

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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.
机译:系统性红斑狼疮(SLE)的火炬可能会在怀孕和产褥期发生。我们研究了在多族裔的SLE队列中怀孕期间和Partum期间的SLE复发相关的患病率和因素。参加门诊诊所的连续SLE患者被审查了我们所在机构的妊娠历史。包括完整的产前,交付和后部后的患者。回顾性分析他们的病历以评估妊娠前/概念,产前期间的疾病活动和产后期。记录了妊娠期妊娠疫发作的存在。记录的妊娠结果包括活产,胎儿丧失,早产和子宫内生长限制(IUGR)。进行与广义估计方程(GEE)分析的单变量和多变量的逻辑回归,以确定与疾病复发和妊娠结果相关的因素。共有120名患有196名妊娠的120名患者,产卵率为78.6%。在怀孕期间被诊断出患有四次(2.0%)。妊娠期爆发率为40.1%,而Partum产后17.4%。妊娠的大多数血液学系统发生(62.3%),其次是肾(53.2%),肌肉骨骼(22.1%)和粘膜(14.3%)。在GEE分析中,概念的活性疾病是怀孕期间和后的SLE复发的独立预测因子,而老年产妇年龄和马来的种族在闺房中与更高的火炬相关联。 HCQ使用与单变量分析中的耀斑风险降低了显着相关,但在GEE分析中不再重要。妊娠中疾病的存在明显与早产具有显着相关。总之,由于怀孕前和怀孕期间和妊娠期疾病复发相关,需要在静态状态下计划SLE的妊娠。马来患者患者突发风险增加了,但需要进一步更大的前瞻性研究来确认不同祖先背景的怀孕关联。

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