Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia
Identifieur interne : 000522 ( Main/Exploration ); précédent : 000521; suivant : 000523Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia
Auteurs : Syahrul Sazliyana Shaharir [Malaisie] ; Mohd Shahrir Mohamed Said [Malaisie] ; Rozita Mohd [Malaisie] ; Rizna Abdul Cader [Malaisie] ; Ruslinda Mustafar [Malaisie] ; Rahana Abdul Rahman [Malaisie]Source :
- PLoS ONE [ 1932-6203 ] ; 2019.
Abstract
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.
Url:
DOI: 10.1371/journal.pone.0222343
PubMed: 31539383
PubMed Central: 6754159
Affiliations:
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xml:lang="fr">Malaisie</country><wicri:regionArea>Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Mohamed Said, Mohd Shahrir" sort="Mohamed Said, Mohd Shahrir" uniqKey="Mohamed Said M" first="Mohd Shahrir" last="Mohamed Said">Mohd Shahrir Mohamed Said</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Mohd, Rozita" sort="Mohd, Rozita" uniqKey="Mohd R" first="Rozita" last="Mohd">Rozita Mohd</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Abdul Cader, Rizna" sort="Abdul Cader, Rizna" uniqKey="Abdul Cader R" first="Rizna" last="Abdul Cader">Rizna Abdul Cader</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Mustafar, Ruslinda" sort="Mustafar, Ruslinda" uniqKey="Mustafar R" first="Ruslinda" last="Mustafar">Ruslinda Mustafar</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author><author><name sortKey="Abdul Rahman, Rahana" sort="Abdul Rahman, Rahana" uniqKey="Abdul Rahman R" first="Rahana" last="Abdul Rahman">Rahana Abdul Rahman</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur, Malaysia</addr-line></nlm:aff><country xml:lang="fr">Malaisie</country><wicri:regionArea>Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Kuala Lumpur</wicri:regionArea><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>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.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Uramoto, Km" uniqKey="Uramoto K">KM Uramoto</name></author><author><name sortKey="Michet, Cj" uniqKey="Michet C">CJ Michet</name></author><author><name sortKey="Thumboo, J" uniqKey="Thumboo J">J Thumboo</name></author><author><name sortKey="Sunku, J" uniqKey="Sunku J">J Sunku</name></author><author><name sortKey="O Fallon, Wm" uniqKey="O Fallon W">WM O'Fallon</name></author><author><name sortKey="Gabriel, Se" uniqKey="Gabriel S">SE Gabriel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tsokos, Gc" uniqKey="Tsokos G">GC Tsokos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Manson, Jj" uniqKey="Manson J">JJ Manson</name></author><author><name sortKey="Rahman, A" uniqKey="Rahman A">A Rahman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey=" Stensen, M" uniqKey=" Stensen M">M. 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uniqKey="Li W">W Li</name></author><author><name sortKey="Cai, X" uniqKey="Cai X">X Cai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gilda Parastandechehr, Stf" uniqKey="Gilda Parastandechehr S">STF Gilda Parastandechehr</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lockshin, Md" uniqKey="Lockshin M">MD Lockshin</name></author><author><name sortKey="Reinitz, E" uniqKey="Reinitz E">E Reinitz</name></author><author><name sortKey="Druzin, Ml" uniqKey="Druzin M">ML Druzin</name></author><author><name sortKey="Murrman, M" uniqKey="Murrman M">M Murrman</name></author><author><name sortKey="Estes, D" uniqKey="Estes D">D Estes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Meehan, Rt" uniqKey="Meehan R">RT Meehan</name></author><author><name sortKey="Dorsey, Jk" uniqKey="Dorsey J">JK Dorsey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Petri, M" uniqKey="Petri M">M Petri</name></author><author><name sortKey="Howard, D" uniqKey="Howard D">D Howard</name></author><author><name sortKey="Repke, J" uniqKey="Repke J">J Repke</name></author><author><name sortKey="Goldman, Dw" uniqKey="Goldman D">DW Goldman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rubbert, A" uniqKey="Rubbert A">A Rubbert</name></author><author><name sortKey="Pirner, K" uniqKey="Pirner K">K Pirner</name></author><author><name sortKey="Wildt, L" uniqKey="Wildt L">L Wildt</name></author><author><name sortKey="Kalden, Jr" uniqKey="Kalden J">JR Kalden</name></author><author><name sortKey="Manger, B" uniqKey="Manger B">B Manger</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Malaisie</li></country></list><tree><country name="Malaisie"><noRegion><name sortKey="Shaharir, Syahrul Sazliyana" sort="Shaharir, Syahrul Sazliyana" uniqKey="Shaharir S" first="Syahrul Sazliyana" last="Shaharir">Syahrul Sazliyana Shaharir</name></noRegion><name sortKey="Abdul Cader, Rizna" sort="Abdul Cader, Rizna" uniqKey="Abdul Cader R" first="Rizna" last="Abdul Cader">Rizna Abdul Cader</name><name sortKey="Abdul Rahman, Rahana" sort="Abdul Rahman, Rahana" uniqKey="Abdul Rahman R" first="Rahana" last="Abdul Rahman">Rahana Abdul Rahman</name><name sortKey="Mohamed Said, Mohd Shahrir" sort="Mohamed Said, Mohd Shahrir" uniqKey="Mohamed Said M" first="Mohd Shahrir" last="Mohamed Said">Mohd Shahrir Mohamed Said</name><name sortKey="Mohd, Rozita" sort="Mohd, Rozita" uniqKey="Mohd R" first="Rozita" last="Mohd">Rozita Mohd</name><name sortKey="Mustafar, Ruslinda" sort="Mustafar, Ruslinda" uniqKey="Mustafar R" first="Ruslinda" last="Mustafar">Ruslinda Mustafar</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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