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Management and outcomes of pregnancy with or without lupus nephritis : a systematic review and meta-analysis

Jiayue Wu (UGent) , Jinghang Ma, Wei Hong Zhang (UGent) and Wen Di
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Abstract
Background: Although it is well established that systemic lupus erythematosus (SLE) negatively affects pregnancy outcomes, there is insufficient evidence on the effect of lupus nephritis (LN) on antenatal management and pregnancy outcomes. We performed a systematic review and meta-analysis to determine the association of LN with management and pregnancy outcomes in SLE patients. Methods: Embase, Medline, Cochrane, and ClinicalTrials.gov were carefully searched for relevant English and Chinese language studies. A total of 2,987 articles were reviewed. Data were extracted that compared management and pregnancy outcomes in SLE pregnant women with LN vs without LN. Risk of bias was assessed by a modified version of the Newcastle-Ottawa Scale and the STROBE checklist. Combined odds ratios (OR) and 95% confidence intervals (CI) were obtained and sensitivity analysis was performed using RevMan 5.3 software. Results: Sixteen studies, including 1,760 pregnant patients with SLE, were included. Gestational hypertension (OR=5.65, 95% CI=2.94-10.84), preeclampsia (OR=2.84, 95% CI=1.87-4.30), SLE flare (OR=2.66, 95% CI=1.51-4.70), renal flare (OR=15.18, 95% CI=5.89-39.14), proteinuria (OR=8.86, 95% CI=4.75-16.52), and hypocomplementemia (OR=2.86, 95% CI=1.68-4.87) were significantly affected in pregnant women with LN. Anti-Sjogren's syndrome-related antigen A/Ro autoantibodies were negatively associated with pregnant women with LN (OR=0.57, 95% CI=0.33-0.98). Pregnant women with LN presented a significant decrease in live births (OR=0.62, 95% CI=0.49-0.80) and a significant increase in preterm births (OR=1.92, 95% CI=1.49-2.49) and fetal growth restriction (OR=1.43, 95% CI=1.08-1.91). Regarding antenatal management, steroids (OR=2.48, 95% CI=1.59-3.87) and immunosuppressant treatment (OR=6.77, 95% CI=3.30-13.89) were more frequently used in women with LN. Conclusion: This review identified a significant association between the aforementioned outcomes and SLE pregnant patients with LN. In patients with SLE, LN increased the risks for adverse pregnancy outcomes and the use of medication. Therefore, special treatment and close monitoring should be allocated to pregnant women with LN.
Keywords
systemic lupus erythematosus, lupus nephritis, maternal outcomes, fetal outcomes, antenatal management, DISEASE-ACTIVITY INDEX, FETAL OUTCOMES, REVISED CRITERIA, SLE PATIENTS, ERYTHEMATOSUS, WOMEN, CLASSIFICATION, PREDICTORS, ASSOCIATION, ANTIBODIES

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Chicago
Wu, Jiayue, Jinghang Ma, Wei Hong Zhang, and Wen Di. 2018. “Management and Outcomes of Pregnancy with or Without Lupus Nephritis : a Systematic Review and Meta-analysis.” Therapeutics and Clinical Risk Management 14: 885–901.
APA
Wu, J., Ma, J., Zhang, W. H., & Di, W. (2018). Management and outcomes of pregnancy with or without lupus nephritis : a systematic review and meta-analysis. THERAPEUTICS AND CLINICAL RISK MANAGEMENT, 14, 885–901.
Vancouver
1.
Wu J, Ma J, Zhang WH, Di W. Management and outcomes of pregnancy with or without lupus nephritis : a systematic review and meta-analysis. THERAPEUTICS AND CLINICAL RISK MANAGEMENT. 2018;14:885–901.
MLA
Wu, Jiayue et al. “Management and Outcomes of Pregnancy with or Without Lupus Nephritis : a Systematic Review and Meta-analysis.” THERAPEUTICS AND CLINICAL RISK MANAGEMENT 14 (2018): 885–901. Print.
@article{8603407,
  abstract     = {Background: Although it is well established that systemic lupus erythematosus (SLE) negatively affects pregnancy outcomes, there is insufficient evidence on the effect of lupus nephritis (LN) on antenatal management and pregnancy outcomes. We performed a systematic review and meta-analysis to determine the association of LN with management and pregnancy outcomes in SLE patients. 
Methods: Embase, Medline, Cochrane, and ClinicalTrials.gov were carefully searched for relevant English and Chinese language studies. A total of 2,987 articles were reviewed. Data were extracted that compared management and pregnancy outcomes in SLE pregnant women with LN vs without LN. Risk of bias was assessed by a modified version of the Newcastle-Ottawa Scale and the STROBE checklist. Combined odds ratios (OR) and 95\% confidence intervals (CI) were obtained and sensitivity analysis was performed using RevMan 5.3 software. 
Results: Sixteen studies, including 1,760 pregnant patients with SLE, were included. Gestational hypertension (OR=5.65, 95\% CI=2.94-10.84), preeclampsia (OR=2.84, 95\% CI=1.87-4.30), SLE flare (OR=2.66, 95\% CI=1.51-4.70), renal flare (OR=15.18, 95\% CI=5.89-39.14), proteinuria (OR=8.86, 95\% CI=4.75-16.52), and hypocomplementemia (OR=2.86, 95\% CI=1.68-4.87) were significantly affected in pregnant women with LN. Anti-Sjogren's syndrome-related antigen A/Ro autoantibodies were negatively associated with pregnant women with LN (OR=0.57, 95\% CI=0.33-0.98). Pregnant women with LN presented a significant decrease in live births (OR=0.62, 95\% CI=0.49-0.80) and a significant increase in preterm births (OR=1.92, 95\% CI=1.49-2.49) and fetal growth restriction (OR=1.43, 95\% CI=1.08-1.91). Regarding antenatal management, steroids (OR=2.48, 95\% CI=1.59-3.87) and immunosuppressant treatment (OR=6.77, 95\% CI=3.30-13.89) were more frequently used in women with LN. 
Conclusion: This review identified a significant association between the aforementioned outcomes and SLE pregnant patients with LN. In patients with SLE, LN increased the risks for adverse pregnancy outcomes and the use of medication. Therefore, special treatment and close monitoring should be allocated to pregnant women with LN.},
  author       = {Wu, Jiayue and Ma, Jinghang and Zhang, Wei Hong and Di, Wen},
  issn         = {1178-203X},
  journal      = {THERAPEUTICS AND CLINICAL RISK MANAGEMENT},
  language     = {eng},
  pages        = {885--901},
  title        = {Management and outcomes of pregnancy with or without lupus nephritis : a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.2147/TCRM.S160760},
  volume       = {14},
  year         = {2018},
}

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