Análise da ocorrência da rotura prematura de membranas ovulares em uma coorte de mulheres com lúpus eritematoso sistêmico, acompanhadas no Hospital Universitário Pedro Ernesto

Abstract

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that can affect many organs and systems. It occurs predominantly in women and occurs most frequently during menacme between the second and third decades of life, a period that coincides with the usual gestation in the general population, and therefore, conception in women with SLE is not uncommon. Adverse outcomes are more frequent in pregnancies of women with SLE and these complications are even more common when conception occurs during periods of disease activity which increase the risk of miscarriages, intrauterine fetal death, preeclampsia, intrauterine growth restriction (IUGR), prematurity and premature rupture of membranes (PROM). The aim of the present study was to analyze PROM occurrence among 209 pregnancies of 190 women with SLE followed at Hospital Universitário Pedro Ernesto (HUPE), from 2011 to 2018. This is a cohort study with retrospective and prospective data collection, including patients with 4 or more SLE classification criteria (American College of Rheumatology criteria). Early and late gestational losses, cases of fetal malformations and multiple pregnancies were excluded. All included patients signed the approved informed consent form by the Research Ethics Committee of HUPE. Maternal clinical and laboratory characteristics, use of medications, clinical complications during pregnancy and obstetric outcomes were analyzed. Statistical analysis included Student's t-test, Mann-Whitney, chi-square (χ2) and Fisher's exact test. Determination of normal data distribution was analyzed with the Shapiro-Wilk test. The association of demographic variables, clinical manifestations of SLE, disease activity, damage index, medications used and comorbidities association with the PROM was assessend by logistic regression analysis with a significance level of 0.05. The patients mean age at delivery was 28.3 ± 6.1 years with a variation from 15 to 47 years and only 18.7% were planned. The occurrence of PROM was 28.7%, and infection (RR = 3.22), serositis (RR = 2.38) and AC anti RNP (RR = 2.99) were associated risk factors. The use of azathioprine (66.7% versus 41%, p = 0.02) and prednisone (81.5 versus 53.7%, p = 0.02) at the end of pregnancy was associated with preterm PROM (PPROM). PPROM occurred in 12.9% of the total pregnancies and in 45% of the cases of PROM, accounting for 37% of premature births. PROM, both at term and preterm, occurred more frequently than reported in the literature among pregnant women with SLE. Infections during pregnancy was a PROM risk factor. Patients with SLE are potentially more predisposed to clinical complications, and the use of immunosuppressive medications during pregnancy may make them more susceptible to PROM when they do not have anticipated delivery due to maternal or fetal complications.