Sistemik Lupus Eritematozus Hastası Kadınların Doğurganlık ve Gebelik Hakkındaki Düşünceleri

Öz

Çalışmanın amacı, sistemik lupus eritematozus (SLE) hastası kadınların doğurganlık ve gebelik hakkındaki düşüncelerini araştırmak ve elde edilen verileri, farklı gebelik sonuçları olan romatoid artrit (RA) hastaları ve sağlıklı bireyler ile karşılaştırmaktı. Çalışmaya 100 SLE hastası, 100 RA hastası ve 103 sağlıklı birey dahil edildi. Çalışma verileri, sosyodemografik özellikler, hastalık özellikleri, gebelik öyküsü ve gebelik ve doğurganlık hakkındaki düşünceleri içeren bir anket kullanılarak toplandı. Yüzde, ki-kare, Mann-Whitney U ve Kruskal-Wallis analizleri SPSS kullanılarak yapıldı. Düşük (p=0,004) ve ölü doğum (p=0,004) oranları SLE hastalarında daha yüksekti. SLE hastalarının %66'sının hamilelik ve riskleri hakkında bilgilendirildiği, %47'sinin hastalık sonrası hamile kaldığı ve bu oranların RA hastalarına göre anlamlı olarak daha yüksek olduğu (p=0,001) saptandı. SLE hastalarının %31'inin çocuk sahibi olma isteği olduğu (RA=%22 ve HC=%24,3), %37'sinin doğum kontrolü kullandığı ve çoğunun geri çekme yöntemini kullandığı saptandı. Öncelikle çocuk isteyen SLE hastalarının oranı, RA ve HC gruplarına göre anlamlı olarak daha yüksekti (p=0,024). Sonuç olarak, çoğu SLE hastası hamilelik ve riskleri konusunda endişeliydi ve yeni bir çocuk isteyenlerin oranı diğer gruplara göre daha yüksekti. SLE hastalarında hamilelik fikri tanı konulduğu andan itibaren sorgulanmalı ve sağlıklı bir hamilelik sonucu için eğitim ve takip sağlanmalıdır.

Anahtar Kelimeler

• sistemik lupus eritamatozus
• kadın
• gebelik
• hasta eğitimi

Thoughts on Fertility and Pregnancy in Patients with Systemic Lupus Erythematosus

Öz

The aim of the study was to investigate the thoughts of women with systemic lupus erythematosus (SLE) on fertility and pregnancy and to compare the data obtained with those of rheumatoid arthritis (RA) patients with different pregnancy outcomes and healthy individuals (HC). The study included 100 SLE patients, 100 RA patients and 103 HC. The study data were collected using a questionnaire that included sociodemographic characteristics, disease characteristics, pregnancy history, and thoughts about pregnancy and fertility. Percentage, chi-square, Mann-Whitney U and Kruskal-Wallis analyses were performed using SPSS. The rates of miscarriage (p<0.001) and stillbirth (p=0.004) were higher in SLE patients. It was found that 66% of SLE patients were informed about pregnancy and its risks, 47% became pregnant after the disease, and the rates were significantly higher than RA patients (p<0.001). It was found that 31% of SLE patients had a desire to have children (RA=22% and HC=24.3%), 37% used contraception, and most of them used the withdrawal method. The proportion of SLE patients who primarily wanted a child was significantly higher than in the RA and HC groups (p=0.024). As a result, most SLE patients were concerned about pregnancy and its risks, and the proportion of those who wanted a new child was higher than in the other groups. The idea of pregnancy should be questioned in SLE patients from the time of diagnosis, and education and follow-up should be provided to plan for a healthy pregnancy outcome.

Anahtar Kelimeler

• systemic lupus erythematosus
• woman
• pragnancy
• patient education

Kaynakça

1. 1. Galappatthy P, Jayasinghe JDD, Paththinige SC, et al. Pregnancy outcomes and contraceptive use in patients with systemic lupus erythematosus, rheumatoid arthritis and women without a chronic illness: a comparative study. Int J Rheum Dis 2017;20(6):746-754. https://doi.org/10.1111/1756-185X.12996
2. 2. Fanouriakis A, Tziolos N, Bertsias G, et al. Update οn the diagnosis and management of systemic lupus erythematosus. Ann Rheum Dis 2021;80(1):14-25. https://doi.org/10.1136/annrheumdis-2020-218272
3. 3. Andreoli L, Crisafulli F, Tincani A. Pregnancy and reproductive aspects of systemic lupus erythematosus. Curr Opin Rheumatol 2017;29(5):473-479.
4. 4. Gohr M, Jakobsen IM, Helmig RB, et al. Improved pregnancy outcomes in systemic lupus erythematosus: A retrospective study of pregnancies from a single centre in Denmark from 2010–2020 compared with the period 1990–2010. Lupus 2022;31(10):1202-1210. https://doi.org/10.1177/09612033221107538
5. 5. Al-Husban N, Abu-Hassan DW, Saleem RAA, et al. Therapeutic changes of systemic lupus erythematosus (SLE) patients in pregnancy and feto-maternal outcomes: a retrospective cohort study. J Int Med Res 2024;52(1):1-14. https://doi.org/10.1177/03000605231225349
6. 6. Çetin Ç, Saraç-Sivrikoz T, Ateş-Tıkız M, et al. The correlation between pregnancy, disease activity and adverse pregnancy outcomes in patients with systemic lupus erythematosus. Lupus 2023;32(13):1509-1517. https://doi.org/10.1177/09612033231208844
7. 7. Wei S, Lai K, Yang Z, et al. Systemic lupus erythematosus and risk of preterm birth: a systematic review and meta-analysis of observational studies. Lupus 2017; 26(6): 563-571.
8. 8. Tarter L, Bermas BL. Expert perspective on a clinical challenge: lupus and pregnancy. Arthritis Rheumatol 2024;76:321-331. https://doi.org/10.1002/art.42756

9. 9. Brites L, Silva S, Andreoli L, et al. Effectiveness of reproductive health counseling of women with systemic lupus erythematosus: observational cross-sectional study at an academic lupus clinic. Rheumatol Int 2021;41(2):403-408. https://doi.org/10.1007/s00296-020-04671-910
10. 10. Iwanowicz-Palus G, Zarajczyk M, Pięta B, et al. Quality of life, social support, acceptance of illness, and self-efficacy among pregnant women with hyperglycemia. Int J Environ Res Public Health 2019;16(20):3941. https://doi.org/10.3390/ijerph16203941.11.
11. 11. Zusman EZ, Sayre EC, Aviña-Zubieta JA, et al. Patterns of medication use before, during and after pregnancy in women with systemic lupus erythematosus: a population-based cohort study. Lupus 2019;28(10):1205-1213. https://doi.org/10.1177/0961203319863111
12. 12. Sangah AB, Jabeen S, Hunde MZ, et al. Maternal and fetal outcomes of SLE in pregnancy: a literature review. J Obstet Gynaecol 2023;43(1):2205513 https://doi.org/10.1080/01443615.2023.2205513
13. 13. Sims CA, Eudy AM, Doss J, et al. The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus. Lupus 2023;32(14):1666-1674. https://doi.org/10.1177/09612033231216602
14. 14. Dalkılıç E, Tufan AN, Oksuz MF, et al. Comparing female-based contraseptive methods in patients with systemic lupus erythematosus, rheumatoid arthritis and a healthy population. Int J Rheum Dis 2014;17(6):653-657.
15. 15. Gupta A, De Vera MA, Rebić N, et al. Pre-pregnancy planning for female patients seen at a pregnancy and rheumatic diseases clinic: a retrospective analysis of patients with rheumatic diseases seeking pregnancy-related care. Rheumatol Int 2024;44:283-289. https://doi.org/10.1007/s00296-023-05398-z
16. 16. Blomjous BS, Johanna IPV, Zijlstra E, et al. Desire to have children and preferences regarding to pre-pregnancy counselling in women with SLE. Rheumatology (Oxford) 2021;60(6):2706-2713. https://doi.org/10.1093/rheumatology/keaa684
17. 17. Petri M, Orbai A-M, Alarcón GS, et al. Derivation and validation of Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012;64:2677-2686.
18. 18. Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology (Oxford) 2012;51(Suppl 6):vi5-9. https://doi.org/10.1093/rheumatology/kes279.
19. 19. Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017;76(3):476-485. https://doi.org/10.1136/annrheumdis-2016-209770.
20. 20. Zhang S, Han X, Liu W, et al. Pregnancy in patients with systemic lupus erythematosus: a systematic review. Arch Gynecol Obstet 2023;308:63-71. https://doi.org/10.1007/s00404-022-06718-7
21. 21. Saulescu IC, Opris-Belinski D, Balanescu AR, et al. Preparing for pregnancy in women with systemic lupus erythematosus-a multidisciplinary approach. Medicina 2022;58(10):1371. https://doi.org/10.3390/medicina58101371
22. 22. Clowse MEB, Li J, Snyderman A, et al. Alignment of contraception use with the ACR reproductive health guidelines in women with systemic lupus erythematosus within the RISE registry. Lupus Sci Med 2024;11(2):e001192. https://doi.org/10.1136/lupus-2024-001192
23. 23. Mobini M, Mohammadpour RA, Salehi Y, et al. Contraceptive prevalence and consulting service in women with systemic lupus erythematosus: a cross-sectional study. Ethiop J Health Sci 2021;31(2):293-298. https://doi.org/10.4314/ejhs.v31i2.12
24. 24. Teng YKO, Bredewold EOW, Rabelink TJ, et al. An evidence-based approach to pre-pregnancy counselling for patients with systemic lupus erythematosus. Rheumatology (Oxford) 2018;57(10):1707-1720. https://doi.org/10.1093/rheumatology/kex374
25. 25. El Miedany Y, Palmer D. Rheumatology-led pregnancy clinic: enhancing the care of women with rheumatic diseases during pregnancy. Clin Rheumatol 2020;39:3593-3601. https://doi.org/10.1007/s10067-020-05173-6