Muñoz, Candido Muñoz;
Goulden, Bethan;
Ahmed, Kawser;
Alijotas-Reig, Jaume;
Giles, Ian;
(2023)
Risk of adverse pregnancy outcomes prior to the onset of an autoimmune rheumatic disease: a systematic review.
Rheumatology
, 62
(2)
pp. 497-511.
10.1093/rheumatology/keac417.
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Abstract
OBJECTIVES: An increased risk of adverse maternal and fetal pregnancy complications including pre-eclampsia, intrauterine growth restriction and small for gestational age, is well-described in women with autoimmune rheumatic disease (ARD) compared with the general population (GP). It is less clear however, whether this risk of adverse pregnancy outcome (APO) also exists in women with "preclinical ARD" (preARD) before they are diagnosed with an ARD many years post-partum. Therefore, we have undertaken a systematic review of available evidence on APO in patients who subsequently were diagnosed with a rheumatic disease to identify whether there is an increased risk in preARD. // METHODS: The present study was reported in accordance with the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. A systematic literature review was performed using the online PubMed database. PreSLE and preRA patients were defined as those who, over the subsequent years, developed Systemic Lupus Erythematosus (SLE) or Rheumatoid Arthritis (RA) according to international classification criteria. // RESULTS: A total of 176 articles were screened and 27 original articles selected for final analysis. PreRA was the most studied group with 15 studies of > 1600 pregnancies and preSLE was the second most studied preARD in pregnancy with 14 studies of > 1000 pregnancies. We found that patients who subsequently develop SLE have an increased burden of poor pregnancy outcomes compared with pregnant women from the GP but less APO compared with SLE pregnancies. In contrast, a similar rate of APO was found when preRA were compared with GP pregnancies.// CONCLUSION: Our findings of an increased risk of APO in certain preARD highlights the relevance of an obstetric history during the first rheumatology appointment and the need for novel screening strategies to predict APO. Further research is required to elucidate the immune basis of adverse pregnancy outcomes in preclinical and clinical ARD.
| Type: | Article |
|---|---|
| Title: | Risk of adverse pregnancy outcomes prior to the onset of an autoimmune rheumatic disease: a systematic review |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/rheumatology/keac417 |
| Publisher version: | https://doi.org/10.1093/rheumatology/keac417 |
| Language: | English |
| Additional information: | © The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
| Keywords: | Lupus, adverse pregnancy outcomes, autoimmune rheumatic disease, obstetric complications, rheumatoid arthritis |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10153587 |
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