The Correlation between Event Occurs before Pregnancy and Successful Delivery with SLE in Taiwan

• Main Authors: Chun-Yi Yeh, 葉純宜
• Other Authors: Yu-Chun Chen
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/p8wmwq

碩士 === 國立陽明大學 === 醫務管理研究所 === 105 === Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease, affects women of reproductive age. Pregnancy outcome is a major concern to most SLE patients.This study was to analyze the association of medical treatment records before pregnancy and successful delivery with SLE in Taiwan. Materials: This retrospective cohort study includes data from the National Health Research Databases in Taiwan dated from 2000 to 2006. We enrolled all SLE patients aged 20 to 40 year-old who had received at least three or more prenatal care during the study period. All the data including pregnancy age, prenatal care utilization, 180 days before pregnancy the number of emergency medical treatment and hospitalizations were collected and analyzed. Results: There were totally 2,299 SLE patients those had a total of 3,159 pregnant records with successful delivery rate at 37.6% (1,188 successful deliveries) during 2000-2006. More than one third of the patients were unstable (probably unplanned pregnancy) and had acute events including emergency department (ER) visits or hospitalization (ER visits: 25.3%, hospitalization: 20.7%) in 180 days prior to their first prenatal care. Unstable patients had lower successful delivery rate (ER visits: 19.8%, hospitalization: 13.9%). The successful delivery rates are even lower for patients received acute care for their SLE flare-up (Methylprednisolone pulse therapy: 13.95%, Cyclophosphamide therapy: 13.33%, Plasmapheresis had no successful delivery). The multiple regression model suggested that age and an unstable pregnant course (had acute events during pregnancy) were independent predictors for a successful delivery (adjusted odds ratio (aOR) for ER visit: 0.510, 95% CI:0.404-0.643, hospitalization aOR: 0.378, 95% CI:0.287-0.498, Methyl-prednisolone pulse therapy aOR: 0.372, 95% CI:0.191-0.725, Cyclophosphamide therapy aOR: 0.409, 95% CI:0.209-0.799). Conclusion: Our study showed that acute events during pregnancy is the only modifiable independent risk factors for successful delivery for SLE patients. A health education on planned pregnancy is highly necessary for SLE patients.