Preterm birth is strongly affected by the glucocorticoid dose during pregnancy in women complicated by systemic lupus erythematosus

Shimada, Hiromi; Wakiya, Risa; Kanenishi, Kenji; Miyatake, Nobuyuki; Nakashima, Shusaku; Mansour, M. H.; Kato, M.; Miyagi, T.; Sugihara, Koichi; Ushio, Yusuke; Mino, Rina; Mizusaki, Mao; Kameda, Tomohiro; Kadowaki, Norimitsu; Dobashi, Hiroaki

doi:10.1186/s13075-021-02699-1

Cited by 14 publications

(17 citation statements)

References 35 publications

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“…We reported that in pregnancies complicated with SLE, the cutoff dosage of glucocorticoids affecting preterm birth is as low as 10 mg/day. [24] In this study, preterm birth occurred in 2 pregnancies with glucocorticoid treatment at a mean dosage of <20 mg/day. These results suggest that even a glucocorticoid dosage of below 20 mg/day is associated with preterm birth.…”

Section: Discussionmentioning

confidence: 88%

Pregnancy course and outcomes of patients with polymyositis and dermatomyositis (PM/DM) managed in a single center

et al. 2023

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We aimed to determine the association between disease activity during pregnancy and pregnancy outcomes of women with polymyositis and dermatomyositis (PM/DM). Patients with PM/DM who were managed from pregnancy to delivery at Kagawa University Hospital from March 2006 to May 2021 were enrolled. Clinical data were retrospectively analyzed to evaluate the association between disease activity during pregnancy and pregnancy outcomes. Eight pregnancies in 5 women with PM/DM were analyzed. The mean age at conception was 28.3 ± 3.8 years, and mean disease duration was 6.3 ± 3.2 years. Four patients required an increased glucocorticoid dosage because of worsening disease activity (sustained elevation of creatine phosphokinase [CPK] concentration). Two patients who continuously received immunosuppressive drugs from conception to delivery showed no increase in disease activity and did not need increased glucocorticoid dosages. The pregnancy outcomes were 1 spontaneous abortion and 7 live births. The mean gestation length was 35.3 ± 5.2 weeks, and mean birthweight was 2297.7 ± 1041.4 g. Five adverse pregnancy outcomes (APOs) occurred (2 preterm births and 4 low birthweights); most of these cases had sustained elevation of CPK concentration and increased glucocorticoid dosages. No APOs occurred in the 2 patients who received continuous immunosuppressive medication. Continued use of pregnancy-compatible medications and control of disease activity with lower glucocorticoid dosages in pregnancies with PM/DM may be important to achieve good pregnancy outcomes.

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Section: Discussionmentioning

confidence: 88%

Pregnancy course and outcomes of patients with polymyositis and dermatomyositis (PM/DM) managed in a single center

et al. 2023

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“…1–5 Previous studies have shown that a high disease activity, antiphospholipid antibodies, lupus nephritis, and the glucocorticoid dose are risk factors for these APOs. 6–16 We have also shown that disease activity parameters and glucocorticoids were associated with APOs and the Apgar scores of newborns. 11,16 Thus, uncontrolled disease activity and its parameters, such as complement or anti-double-stranded DNA (anti-dsDNA) antibodies, are strongly related to APOs, and the strict control of SLE disease activity in women with SLE who hope to become pregnant is required.…”

Section: Introductionmentioning

confidence: 80%

Immunological disease activity parameters at conception are risk factors for preterm birth and low birth weight in patients with systemic lupus erythematosus

Shimada

Wakiya

Kameda

et al. 2023

Lupus

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Objective This study aimed to identify which disease activity parameters may be risk factors for preterm birth (PB) and low birth weight (LBW) in patients with systemic lupus erythematosus (SLE). We also analyzed the extent to which these parameters affected PB and LBW. Methods We collected the SLE Disease Activity Index (SLEDAI), the rate of lupus low disease activity state (LLDAS) attainment, complement levels, and the titer of anti-double stranded DNA (dsDNA) antibody as disease activity parameters. We retrospectively analyzed the associations of these parameters with PB and LBW. Results Sixty pregnancies were included in this study. C3 levels and anti-dsDNA antibody titers at conception were strongly associated with PB ( p = 0.03 and p = 0.01, respectively), whereas C3 and CH50 levels were associated with LBW ( p = 0.02 and p = 0.03, respectively). A logistic regression analysis showed that the cutoff values of C3 and anti-dsDNA antibody for PB were 62.0 mg/dl and 5.4 IU/ml, respectively. The cutoff values of C3 and CH50 for LBW were 87.0 mg/dl and 41.8 U/ml, respectively. The risk of PB or LBW was increased when divided by the cutoff value, and the combination of these cutoff values showed a significantly higher risk of PB and LBW ( p = 0.01 and p < 0.01, respectively). Conclusions PB and LBW are strongly associated with disease activity parameters in patients with SLE. Therefore, strictly monitoring and controlling these disease activity parameters, with or without clinical manifestation, is important for women who want to become mothers.

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“…Hochrisikofaktoren Frühgeburten bei SLE sind mit höheren Glukokortikoid-(GK)-Dosen in der Früh-und Spätschwangerschaft assoziiert [12]. Neu ist, dass bereits eine niedrigere GK-Dosis als bisher angenommen in signifikantem Zusammenhang mit Schwangerschaftskomplikationen, speziell Frühgeburten, steht (Cut-off-Werte der mittleren GK-Dosis zwischen 6,5 und 10,0 mg/Tag) [13].…”

Section: Moderate Risikofaktoren *2unclassified

Aktuelles zu Schwangerschaften bei entzündlich-rheumatischen Erkrankungen

Fischer‐Betz

2023

Dtsch Med Wochenschr

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Was ist neu? Planung von Schwangerschaften Fragen der Familienplanung sind ein wichtiger Bestandteil in der Betreuung von Patientinnen mit entzündlich-rheumatischen Erkrankungen. Die Thematik sollte frühzeitig angesprochen werden. Eine sorgfältige Planung führt nachweislich zu mehr erfolgreichen und komplikationsarmen Schwangerschaften. Zunehmend in den Fokus rückt das Screening nach Risikofaktoren für eine Präeklampsie, da sich hieraus die Indikation zu einer prophylaktischen Einnahme von niedrig dosiertem Aspirin ab der Frühschwangerschaft ergeben kann. Neuere Empfehlungen unterstützen dabei praxisnah. Schwangerschaftsverlauf Bei Frauen mit Rheumatoider Arthritis oder Spondyloarthritis, die mit biologischen krankheitsmodifizierenden antirheumatischen Medikamenten (bDMARDs) behandelt werden, sollte eine Fortsetzung der Medikamentengabe während der Schwangerschaft in Betracht gezogen werden, um das Risiko eines Krankheitsschubs und nachteiliger Schwangerschaftsfolgen zu reduzieren. Bei SLE-Schwangerschaften bietet eine HCQ-Therapie mit einer Reduktion des Risikos einer Präeklampsie und eines kongenitalen AV-Blocks einen Benefit, der über die reine Krankheitskontrolle hinausgeht. Therapie vor, in und nach der Schwangerschaft Eine stabile Erkrankung unter schwangerschaftskompatibler Medikation stellt einen der wichtigsten prädiktiven Faktoren für einen guten Schwangerschaftsverlauf dar. Die Evidenz zur Sicherheit von antirheumatischen Therapien steigt stetig. Aktuelle Empfehlungen sollten in der Beratung beachtet werden.

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Preterm birth is strongly affected by the glucocorticoid dose during pregnancy in women complicated by systemic lupus erythematosus

Cited by 14 publications

References 35 publications

Pregnancy course and outcomes of patients with polymyositis and dermatomyositis (PM/DM) managed in a single center

Pregnancy course and outcomes of patients with polymyositis and dermatomyositis (PM/DM) managed in a single center

Immunological disease activity parameters at conception are risk factors for preterm birth and low birth weight in patients with systemic lupus erythematosus

Aktuelles zu Schwangerschaften bei entzündlich-rheumatischen Erkrankungen

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