Systemic Lupus Erythematosus is Associated With an Increased Frequency of Spontaneous Preterm Births: Systematic Review and Meta-analysis.
Review
Overview
abstract
OBJECTIVE: Preterm birth (PTB) is one of the most frequent complications of pregnancies in women with systemic lupus erythematosus (SLE). The high indicated PTB proportion due to hypertensive disorders of pregnancy and/or fetal growth restriction is well known, and preventive measures as well as screening for early detection are performed. The risk of spontaneous PTB is less well recognized. The purpose of this study is to determine the proportions of spontaneous and indicated PTB in pregnancies of women with SLE DATA SOURCES: A systematic literature search using Pubmed, Embase, Web of Science and Google Scholar was performed in June 2021 STUDY ELIGIBILITY CRITERIA: Studies in pregnant women with SLE reporting spontaneous and indicated PTB rates were selected. Original research articles published from 1995 to June 2021 were included STUDY APPRAISAL AND SYNTHESIS METHODS: Quality and risk of bias of the included studies were assessed using the Newcastle-Ottawa Quality Assessment Scale. To estimate the pooled event rates and 95% confidence intervals, meta-analysis of single proportions with a random-effects model was performed. RESULTS: We included 21 articles, containing data of 8157 pregnancies in women with SLE. On average 31% (95% prediction interval [0.14; 0.50]) of the pregnancies resulted in PTB, including 14% (95% prediction interval [0.04; 0.27]) spontaneous, and 16% (95% prediction interval [0.03; 0.35])indicated PTB CONCLUSIONS: In pregnant women with SLE, spontaneous as well as indicated PTB proportions are high. This information should be applied in (pre-pregnancy) counselling and management in pregnancy. The knowledge obtained by this meta-analysis, paves the way for further research of associated risk factors and development of interventions to reduce spontaneous PTB in SLE pregnancies.
