Abstract
BackgroundWe aimed to systematically compare arterial/venous thrombosis, fetal loss and stillbirth in pregnant women with systemic lupus erythematosus (SLE), primary anti-phospholipid syndrome (PAPS) and secondary anti-phospholipid syndrome (SAPS).MethodsOnline databases were carefully searched for relevant publications comparing SLE with PAPS and/or SAPS in pregnancy. Studies were included if: they compared SLE with APS [SLE versus PAPS or SLE versus SAPS or SLE versus PAPS and SAPS respectively] in pregnant women; and they reported specific adverse outcomes as their clinical endpoints including arterial/venous thrombosis, fetal loss and stillbirth. Risk ratios (RR) with 95% confidence intervals (CIs) were used as statistical parameters and the analysis was carried out by the RevMan 5.3 software.ResultsA total number of 941 pregnant women were included: 556 were candidates of SLE; 200 were candidates of PAPS; and 185 were candidates of SAPS. APS was associated with a significantly higher risk of fetal loss (RR: 4.49, 95% CI: 2.09–9.64; P = 0.0001). In addition, stillbirth and arterial/venous thrombosis were also significantly increased with APS (RR: 6.65, 95% CI: 2.14–20.60; P = 0.001) and (RR: 3.95, 95% CI: 1.28–12.16; P = 0.02) respectively.When patients with PAPS were compared with patients who suffered from SLE alone, fetal loss and arterial/venous thrombosis were still significantly higher with the former.When SAPS were compared with SLE (without anti-phospholipid antibodies), arterial/venous thrombosis, stillbirth and fetal loss were still significantly higher with SAPS. However, no significant difference was observed in arterial/venous thrombosis and fetal loss between PAPS and SAPS.ConclusionsPAPS and SAPS were associated with significantly higher arterial/venous thrombosis, fetal loss and stillbirth in comparison to SLE. However, no significant difference was observed when PAPS was compared to SAPS.
Highlights
We aimed to systematically compare arterial/venous thrombosis, fetal loss and stillbirth in pregnant women with systemic lupus erythematosus (SLE), primary anti-phospholipid syndrome (PAPS) and secondary anti-phospholipid syndrome (SAPS)
Following an assessment of the titles and abstracts, which was an integral part of the eligibility criteria, 1747 articles were eliminated for irrelevancy
Comparing adverse outcomes in PAPS versus SLE When patients with PAPS were compared with patients who suffered from SLE alone, fetal loss was still significantly higher with the former
Summary
We aimed to systematically compare arterial/venous thrombosis, fetal loss and stillbirth in pregnant women with systemic lupus erythematosus (SLE), primary anti-phospholipid syndrome (PAPS) and secondary anti-phospholipid syndrome (SAPS). Systemic lupus erythematosus (SLE) is an autoimmune disorder which affects a small population of women of childbearing age [1]. Even if research focusing on pregnant women with SLE was seldom carried out due to a limited number of similar patients who agreed to participate in research cohorts, requiring several decades to obtain a minimum number of participants, scientific medical reports which were successfully published have shown this disorder to significantly be responsible for adverse maternal and fetal outcomes [2]. New scientific research has shown a clear association of SLE with anti-phospholipid syndrome (APS) [7], mainly secondary anti-phospholipid syndrome (SAPS). The co-existence of APS with SLE has often aggravated the course of the latter
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