Systemic lupus erythematosus is associated with an increased frequency of spontaneous preterm births: systematic review and meta-analysis - 22/04/24

Doi : 10.1016/j.ajog.2024.03.010

Carolien N.H. Abheiden, MD ^a,^b,^⁎ , Birgit S. Blomjous, MD ^c,^d, Ciska Slaager, MD ^e, Anadeijda J.E.M.C. Landman, MD ^a,^b, Johannes C.F. Ket, MD ^f, Jane E. Salmon, PhD ^g, Jill P. Buyon, PhD ^h, Martijn W. Heymans, MD ⁱ, Johanna I.P. de Vries, MD, PhD ^a,^b, Irene E.M. Bultink, MD ^c,^d, Marjon A. de Boer, MD ^a,^b
^a Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands
^b Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
^c Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Amsterdam, the Netherlands
^d Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands
^e Department of Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
^f Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
^g Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
^h NYU Grossman School of Medicine, New York University, New York, NY
ⁱ Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, the Netherlands

^∗Corresponding author: Carolien N.H. Abheiden, MD.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 22 April 2024

Abstract

Objective

Preterm birth is one of the most frequent complications of pregnancy in women with systemic lupus erythematosus. The high indicated preterm birth proportion due to hypertensive disorders of pregnancy and/or fetal growth restriction is well known, and preventive measures and screening for early detection are performed. The risk of spontaneous preterm birth is less well recognized. This study aimed to determine the proportions of spontaneous and indicated preterm birth in pregnancies of women with systemic lupus erythematosus.

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 systemic lupus erythematosus reporting spontaneous and indicated preterm birth rates were selected. Original research articles published from 1995 to June 2021 were included.

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 systemic lupus erythematosus. On average, 31% (95% prediction interval, 0.14–0.50) of the pregnancies resulted in preterm birth, including 14% (95% prediction interval, 0.04–0.27) spontaneous and 16% (95% prediction interval, 0.03–0.35) indicated preterm birth.

Conclusion

In pregnant women with systemic lupus erythematosus, spontaneous and indicated preterm birth proportions are high. This information should be applied in (prepregnancy) counseling 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 preterm birth in systemic lupus erythematosus pregnancies.

Le texte complet de cet article est disponible en PDF.

Video

(2.82 Mo)

Le texte complet de cet article est disponible en PDF.

Key words : iatrogenic preterm birth, indicated preterm birth, lupus, pregnancy, premature, preterm birth, preterm delivery, preterm labor, preterm prelabor rupture of membranes, rupture of membranes, spontaneous preterm birth, systemic lupus erythematosus

Plan

Introduction

Objective

Methods

Eligibility criteria, information sources, and search strategy

Study selection

Data extraction

Assessment of risk of bias

Data synthesis

Results

Study selection

Study characteristics

Risk of bias of included studies

Synthesis of results

Comment

Principal findings

Comparison with existing literature

Strengths and limitations

Conclusions and implications

Appendix

	Drs Blomjous and Abheiden as co-first authors.
	The authors report no conflict of interest.
	The authors report no funding for this study.
	Prospero registration
	Registration date: April 22, 2021.
	Registration number: CRD42021250697
	This study was presented at the 4th European Spontaneous Preterm Birth Congress of the Stichting Stop te vroeg bevallen, Haarlem, the Netherlands, September 20–22, 2023; the abstract was presented at the 14th European Lupus Meeting, SLEuro European Lupus Society, Brugge, Belgium, March 19–22, 2024.