A meta-analysis of the effect of Sjögren′s syndrome on adverse pregnancy outcomes

Geng, Baoqing; Zhang, Keyue; Huang, Xianqian; Chen, Yong

doi:10.1016/j.clinsp.2022.100140

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Sumário

Original articles • Clinics 77 • 2022 • https://doi.org/10.1016/j.clinsp.2022.100140 copy

A meta-analysis of the effect of Sjögren′s syndrome on adverse pregnancy outcomes

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

This study aimed to assess the correlation between Sjögren′s Syndrome (SS) and adverse pregnancy outcomes, with the aim of providing a basis for preconception and pregnancy interventions in women with SS.

Methods

A search of electronic databases in English and Chinese databases from January 2005 to December 2021, was conducted to collect the literature of case-control studies or cohort studies on the association between SS and pregnancy outcome studies. Literature inclusion and data extraction were performed according to established criteria, and the Newcastle-Ottawa scale was used to evaluate the quality of the literature. Stata 15 software was used for meta-analysis.

Results

A total of nine papers were included in this study. Meta-analysis results showed that SS was associated with spontaneous abortion (RR = 8.85, 95% CI 3.10‒25.26), preterm birth (RR = 2.27, 95% CI 1.46‒3.52), low birth mass (RR = 1.99, 95% CI 1.34‒2.97), and birth defects (RR = 4.28, 95% CI 3.08‒5.96).

Conclusion

SS can increase the incidence of adverse pregnancy outcomes.

Keywords
Sjögren's syndrome; Pregnancy outcome; Meta-analysis

Highlights

Dry syndrome can increase the risk of spontaneous abortion and preterm delivery.
Dry syndrome can increase the risk of low birth weight and birth defects.
Clinics should provide comprehensive prenatal counseling and testing for the patients.

Author	Year of publication	Study type	Age (years)		Sample size		Pregnancy outcome	NOS
			Case group	Control group	Case group	Control group		NOS
C Ballester¹¹11 Ballester C, Grobost V, Roblot P, Pourrat O, Pierre F, Laurichesse-Delmas H, et al. Pregnancy and primary Sjögren's syndrome: management and outcomes in a multicentre retrospective study of 54 pregnancies. Scand J Rheumatol. 2017;46(1):56-63.	2017	Retrospective	30.8±6.2	30.8±6.2	54	216	Spontaneous abortion, preterm birth, low birth weight	7
Li L⁹	2019	Prospective	30.4±5.3	31.6±5.2	48	96	Spontaneous abortion, preterm birth	7
S De Carolis¹²12 De Carolis S, Salvi S, Botta A, Garofalo S, Garufi C, Ferrazzani S, et al. The impact of primary Sjogren's syndrome on pregnancy outcome: our series and review of the literature. Autoimmun Rev. 2014;13(2):103-7.	2014	Retrospective	34.8	30.2	34	136	Spontaneous abortion, preterm birth, low birth weight	6
R Priori¹³13 Priori R, Gattamelata A, Modesti M, Colafrancesco S, Frisenda S, Minniti A, et al. Outcome of pregnancy in Italian patients with primary Sjögren syndrome. J Rheumatol. 2013;40(7):1143-7.	2014	Retrospective	Not described	Not described	12	96	Premature birth	5
B Elliott¹⁰10 Elliott B, Spence AR, Czuzoj-Shulman N, Abenhaim HA. Effect of Sjögren's syndrome on maternal and neonatal outcomes of pregnancy. J Perinat Med. 2019;47(6):637-42.	2019	Retrospective	Not described	Not described	1 947	14 511 640	Premature birth, congenital malformations	6
Yang, Jingjing⁸8 Yang J, Liang M. Analysis of maternal and child outcomes and associated factors in patients with combined dry syndrome of pregnancy. Chin J Obstetrics Gynecol. 2021;22(3):228-30.	2021	Prospective	31.89±3.55	30.81±3.73	56	260	Spontaneous abortion, premature birth, and	7
HJ Haga¹⁴14 Haga HJ, Gjesdal CG, Koksvik HS, Skomsvoll JF, Irgens LM, Ostensen M. Pregnancy outcome in patients with primary Sjögren's syndrome. a case-control study. J Rheumatol. 2005;32(9):1734-6.	2005	Retrospective	26	26	36	93	Spontaneous abortion, preterm birth, low birth weight, congenital malformations	7
ZE Hussein¹⁵15 Hussein SZ, Jacobsson LT, Lindquist PG, Theander E. Pregnancy and fetal outcome in women with primary Sjogren's syndrome compared with women in the general population: a nested case-control study. Rheumatology (Oxford). 2011;50(9):1612-7.	2011	Retrospective	33.6±4.2	29.8±5.5	16	80	Spontaneous abortion, preterm birth, low birth mass, congenital malformations	7
JF Xu¹⁶16 Xu J, Chen D, Tian Y, Peng B. Pregnancy outcomes with primary Sjogren's syndrome among Chinese women: a retrospective cohort study. Res Square 2019. doi: 10.21203/rs.2.14389/v1. https://doi.org/10.21203/rs.2.14389/v1....	2019	Retrospective	32.0±4.3	30.3±4.1	64	320	Spontaneous abortion, preterm birth, low birth mass, congenital malformation	6

Adverse pregnancy outcome	Before sensitivity analysis RR (95% CI)	Exclusion of literature with the largest RR		Exclusion of literature with the smallest RR
		Exclusion of literature	RR after exclusion (95% CI)	Exclusion of literature	Post-exclusion RR (95% CI)
Spontaneous abortion	8.85 (3.10‒25.26)	C Ballester	5.73(3.09∼10.65)	Yang Jingjing	10.99(3.79, 31.82)
Premature birth	2.27 (1.46, 3.52)	JF Xu	2.04 (1.33, 3.23)	R Priori	2.46(1.54, 3.92)
Low birth weight	1.99 (1.34, 2.97)	S De Carolis	1.74 (1.11, 2.73)	C Ballester	2.52 (1.61, 3.94)
Birth defects	4.28 (3.08, 5.96)	JF Xu	3.77 (2.69, 5.29)	HJ Haga	8.25 (1.81, 37.61)

Outcome indicators	Begg's test		Egger's test
	Z	p	t	p
Spontaneous abortion	1.594	0.094	3.168	0.016
Premature birth	0.453	0.657	0.951	0.371
Low birth weight	0.395	0.693	1.727	0.136
Birth defects	0.737	0.451	1.238	0.263

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[1] ⁎ Corresponding author. E-mail address: chenyongg4@163.com (Y. Chen).