Objectives An increased risk of adverse maternal and fetal pregnancy complications including pre-eclampsia, intrauterine growth restriction and small for gestational age, is well-described in women with autoimmune rheumatic disease (ARD) compared with the general population (GP). It is less clear however, whether this risk of adverse pregnancy outcome (APO) also exists in women with “preclinical ARD” (preARD) before they are diagnosed with an ARD many years post-partum. Therefore, we have undertaken a systematic review of available evidence on APO in patients who subsequently were diagnosed with a rheumatic disease to identify whether there is an increased risk in preARD. Methods The present study was reported in accordance with the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. A systematic literature review was performed using the online PubMed database. PreSLE and preRA patients were defined as those who, over the subsequent years, developed Systemic Lupus Erythematosus (SLE) or Rheumatoid Arthritis (RA) according to international classification criteria. Results A total of 176 articles were screened and 27 original articles selected for final analysis. PreRA was the most studied group with 15 studies of > 1600 pregnancies and preSLE was the second most studied preARD in pregnancy with 14 studies of > 1000 pregnancies. We found that patients who subsequently develop SLE have an increased burden of poor pregnancy outcomes compared with pregnant women from the GP but less APO compared with SLE pregnancies. In contrast, a similar rate of APO was found when preRA were compared with GP pregnancies. Conclusion Our findings of an increased risk of APO in certain preARD highlights the relevance of an obstetric history during the first rheumatology appointment and the need for novel screening strategies to predict APO. Further research is required to elucidate the immune basis of adverse pregnancy outcomes in preclinical and clinical ARD.

中文翻译：

---

自身免疫性风湿病发作前不良妊娠结局的风险：系统评价

目的 与一般人群 (GP) 相比，患有自身免疫性风湿病 (ARD) 的妇女发生先兆子痫、宫内生长受限和小于胎龄儿等不良母婴妊娠并发症的风险增加。然而，尚不清楚这种不良妊娠结局 (APO) 的风险是否也存在于患有“临床前 ARD” (preARD) 的女性中，这些女性在产后多年才被诊断出患有 ARD。因此，我们对随后被诊断患有风湿病的患者的 APO 的现有证据进行了系统回顾，以确定是否存在 preARD 风险增加。方法 本研究是根据系统评价和荟萃分析 (PRISMA) 标准的首选报告项目的指导进行报告的。使用在线 PubMed 数据库进行了系统的文献综述。根据国际分类标准，PreSLE 和 preRA 患者被定义为在随后的几年中发展为系统性红斑狼疮 (SLE) 或类风湿性关节炎 (RA) 的患者。结果共筛选出176篇文章，最终选取原创文章27篇进行分析。PreRA 是研究最多的组，有 15 项研究 > 1600 次妊娠和 preSLE 是妊娠期研究第二多的 preARD，有 14 项研究 > 1000次怀孕。我们发现，与 GP 的孕妇相比，随后发展为 SLE 的患者妊娠结局不佳的负担增加，但与 SLE 妊娠相比，APO 减少。相比之下，将 preRA 妊娠与 GP 妊娠进行比较时，发现 APO 发生率相似。结论 我们关于某些 preARD 患者 APO 风险增加的发现强调了第一次风湿病预约期间产科病史的相关性以及需要新的筛查策略来预测 APO。需要进一步的研究来阐明临床前和临床 ARD 中不良妊娠结局的免疫基础。