Rheumatology (Oxford, England) · 2026
Impact of systemic autoimmune diseases in maternal, fetal and neonatal outcomes in Spain.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Esteban-Sampedro Jorge, Martín-Portugués Mario, Ruiz-Irastorza Guillermo, Mellor-Pita Susana, Tutor de Ureta Pablo, Durán-Del Campo Pedro, Martínez-Urbistondo María, Fernández-Guitián Román, Castejón Raquel, Fuentes-Moreno Lucía, García Benasach Fátima, Ortega-de la Puente Alfonso, de la Cruz-Echeandía Marina, Moreno-Torres Víctor
Аннотация
OBJECTIVES: Pregnancy in autoimmune disease is increasingly feasible but carries heterogeneous maternal and perinatal risks beyond hypertensive disorders. We aimed to quantify disease-specific risks of maternal, foetal and neonatal outcomes across autoimmune diseases in a nationwide cohort, explicitly distinguishing primary vs secondary APS.
METHODS: We analysed pregnancy-related hospitalizations in Spain (SNHDD, 2016-2022). Exposures were SLE, primary Sjögren syndrome (SjS), MCTD, SSc, sarcoidosis, Behçet disease and APS (primary/secondary). Outcomes included preeclampsia (PE), preeclampsia with severe features (PESC), composite maternal morbidity (caesarean delivery, postpartum hemorrhage, thrombosis, stroke, ICU admission) and composite foetal/neonatal morbidity-mortality (foetal distress, foetal growth restriction, preterm delivery, abruptio placentae, stillbirth, neonatal death).
RESULTS: In 1 973 249 Spanish pregnancy hospitalizations, 5727 involved autoimmune disease. Risks clustered by disease: SLE (PE OR 1.78; PESC 2.17; composite maternal 1.35; foetal/neonatal 1.16), primary APS (PE 1.50; PESC 1.88; maternal 1.66; foetal/neonatal 1.10), secondary APS (PE 2.61; PESC 3.47; maternal 1.94) and MCTD (PE 4.57; PESC 7.24) showed the strongest signals. SSc increased composite maternal (1.62) and foetal/neonatal (1.69) risk; SjS raised caesarean and selected foetal outcomes; Behçet disease mainly increased maternal thrombosis (9.31); and sarcoidosis showed no independent associations.
CONCLUSION: Pregnancies affected by autoimmune disease exhibit distinct, disease-specific patterns of hypertensive, maternal and foetal/neonatal risk, with the most consistently elevated risks observed in SLE, APS (especially secondary) and MCTD. These comparative estimates may support risk-stratified, guideline-concordant care and inform counseling, surveillance and delivery planning, with explicit consideration of comorbidity burden.
METHODS: We analysed pregnancy-related hospitalizations in Spain (SNHDD, 2016-2022). Exposures were SLE, primary Sjögren syndrome (SjS), MCTD, SSc, sarcoidosis, Behçet disease and APS (primary/secondary). Outcomes included preeclampsia (PE), preeclampsia with severe features (PESC), composite maternal morbidity (caesarean delivery, postpartum hemorrhage, thrombosis, stroke, ICU admission) and composite foetal/neonatal morbidity-mortality (foetal distress, foetal growth restriction, preterm delivery, abruptio placentae, stillbirth, neonatal death).
RESULTS: In 1 973 249 Spanish pregnancy hospitalizations, 5727 involved autoimmune disease. Risks clustered by disease: SLE (PE OR 1.78; PESC 2.17; composite maternal 1.35; foetal/neonatal 1.16), primary APS (PE 1.50; PESC 1.88; maternal 1.66; foetal/neonatal 1.10), secondary APS (PE 2.61; PESC 3.47; maternal 1.94) and MCTD (PE 4.57; PESC 7.24) showed the strongest signals. SSc increased composite maternal (1.62) and foetal/neonatal (1.69) risk; SjS raised caesarean and selected foetal outcomes; Behçet disease mainly increased maternal thrombosis (9.31); and sarcoidosis showed no independent associations.
CONCLUSION: Pregnancies affected by autoimmune disease exhibit distinct, disease-specific patterns of hypertensive, maternal and foetal/neonatal risk, with the most consistently elevated risks observed in SLE, APS (especially secondary) and MCTD. These comparative estimates may support risk-stratified, guideline-concordant care and inform counseling, surveillance and delivery planning, with explicit consideration of comorbidity burden.