Risk factors for adverse maternal and fetal outcomes in SLE patients: A systematic review and meta-analysis

Hang Liu^1,2Meifei Li^1,2MeiJiao Wang^1,2Minzhe Ren^1,2Jiaying Fu^1,2Ying Cai^1,2Zhiyu Li³ZHAO Ting^1,2Jing Sun^4*Zhijun Xie^1,4*

• ¹Zhejiang Chinese Medical University, Hangzhou, China
• ²College of Basic Medical Science, China Medical University, Shenyang, Liaoning Province, China
• ³Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Jiangsu Province, China
• ⁴The Second School of Clinical Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China

Objective: The goal of this meta-analysis is to designate the risk factors for unfavorable maternal and fetal outcomes in SLE pregnancies by means of a systematic review of the literature and meta-analysis. Methods: The odds ratios (ORs) and associated 95% confidence intervals (CIs) were estimated using either a fixed-effects model or a random-effects model. The I2 statistic was used to assess heterogeneity. Sensitivity analysis, Egger's test, the Newcastle-Ottawa Quality Assessment Scale (NOS), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system were also performed. Results: Eleven papers with 1,790 SLE patients who were pregnant were examined in the meta-analysis out of 2,467 citations that were screened. The meta-analysis's findings indicated that the onset of SLE is associated with an increased risk of preterm birth (OR: 2.85; 95% CI: 2.04, 3.99). Hypertension is associated with an increased risk of composite pregnancy outcomes (OR: 4.56; 95% CI: 2.42, 8.53), preterm birth (OR: 2.20; 95% CI: 1.53, 3.17) and preeclampsia (OR: 10.11; 95% CI: 1.83, 55.89). Renal involvement is associated with an increased risk of composite pregnancy outcomes (OR: 3.09; 95% CI: 1.66, 5.72) and preterm birth (OR: 1.65; 95% CI: 1.22, 2.23). Anti-dsDNA is associated with an increased risk of preterm birth (OR: 1.83; 95% CI: 1.13, 2.92) and pregnancy loss (OR: 2.64; 95% CI: 1.09, 6.40). Drug therapy is associated with a decreased risk of composite pregnancy outcomes (OR: 0.51; 95% CI: 0.31, 0.85), preterm birth (OR: 0.66; 95% CI: 0.48, 0.89) and pregnancy loss (OR: 0.42; 95% CI: 0.21, 0.84). Sensitivity analysis demonstrated how solid our results are. Egger's test revealed no discernible publication bias. Conclusion: The onset of SLE, hypertension, renal involvement, drug therapy, and serological factors have a predictive effect on the occurrence of adverse maternal and fetal outcomes in SLE pregnancies. Strengthening preconception risk assessment for SLE patients plays an important role in reducing pregnancy risks and improving the quality of life during pregnancy.