Maternal Near Miss in Patients with Systemic Lupus Erythematosus

Abstract Objective Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with SLE may have severe life-threatening risks. The present study aimed to determine the prevalence of severe maternal morbidity (SMM) in patients with SLE and analyze the parameters that contributed to cases of greater severity. Methods This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at a University Hospital in Brazil. The pregnant women were divided in a control group without complications, a group with potentially life-threatening conditions (PLTC), and a group with maternal near miss (MNM). Results The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with the control group (p = 0.0042; odds ratio [OR]: 12.05; 95% confidence interval [CI]: 1.5–96.6 for the MNM group and p = 0.0001; OR: 4.84; 95%CI: 2.2–10.8 for the PLTC group). Severe maternal morbidity increases the risk of longer hospitalization (p < 0.0001; OR: 18.8; 95%CI: 7.0–50.6 and p < 0.0001; OR: 158.17; 95%CI: 17.6–1424,2 for the PLTC and MNM groups, respectively), newborns with low birthweight (p = 0.0006; OR: 3.67; 95%CI: 1.7–7.9 and p = 0.0009; OR: 17.68; 95%CI: 2–153.6) for the PLTC and MNM groups, respectively] as well as renal diseases (PLTC [8.9%; 33/56; p = 0.0069] and MNM [78.6%; 11/14; p = 0.0026]). Maternal near miss cases presented increased risk for neonatal death (p = 0.0128; OR: 38.4; 95%CI: 3.3–440.3]), and stillbirth and miscarriage (p = 0.0011; OR: 7.68; 95%CI: 2.2–26.3]). Conclusion Systemic lupus erythematosus was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes.

摘要 目的 系统性红斑狼疮（Systemic lupus erythematosus, SLE）可造成不可逆的器官损伤。合并SLE的妊娠孕妇面临严重的致命风险。本研究旨在明确SLE患者中严重孕产妇发病率（Severe maternal morbidity, SMM）的患病率，并分析与病情更严重病例相关的危险因素。
方法 本研究为横断面回顾性研究，分析了巴西某大学医院收治的SLE妊娠孕妇的病历数据。将研究对象分为三组：无并发症对照组、存在潜在致命状况组（Potentially life-threatening conditions, PLTC）以及孕产妇濒死病例组（Maternal near miss, MNM）。
结果 孕产妇濒死病例发生率为112.9/1000活产儿。与对照组相比，PLTC组（83.9%）和MNM组（92.9%）的多数病例发生早产，且早产风险具有统计学意义（MNM组：p=0.0042，优势比（Odds Ratio, OR）=12.05，95%置信区间（Confidence Interval, CI）=1.5~96.6；PLTC组：p=0.0001，OR=4.84，95%CI=2.2~10.8）。严重孕产妇发病率与住院时间延长显著相关：PLTC组（p<0.0001，OR=18.8，95%CI=7.0~50.6）及MNM组（p<0.0001，OR=158.17，95%CI=17.6~1424.2）均存在该关联；同时与低出生体重儿的发生相关：PLTC组（p=0.0006，OR=3.67，95%CI=1.7~7.9）及MNM组（p=0.0009，OR=17.68，95%CI=2.0~153.6）。此外，两组均与肾脏疾病相关：PLTC组占比8.9%（33/56，p=0.0069），MNM组占比78.6%（11/14，p=0.0026）。MNM组新生儿死亡风险显著升高（p=0.0128，OR=38.4，95%CI=3.3~440.3），且死胎及流产风险亦升高（p=0.0011，OR=7.68，95%CI=2.2~26.3）。
结论 系统性红斑狼疮与严重孕产妇发病率、住院时间延长以及不良产科和新生儿结局风险升高显著相关。