Pregnancies in patients with Sjögren’s syndrome have ‘very good prognoses’
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Key takeaways:
- Patients with Sjögren’s syndrome do not appear to have a higher risk for adverse pregnancy outcomes.
- Pregnancies in patients with Sjögren’s syndrome demonstrate an overall good prognosis for the parent and fetus.
Pregnancies among patients with Sjögren’s syndrome demonstrate “very good prognoses” for both the parent and fetus, and do not reflect an increased risk for adverse outcomes, according to data published in The Lancet Rheumatology.
“The consequences of connective tissue diseases on pregnancies have mostly been studied in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome, which are more common than primary Sjögren’s syndrome in young women,” Grégoire Martin de Frémont, MD, of the Université Paris-Saclay, in France, and colleagues wrote. “Most studies reported higher frequencies of adverse pregnancy outcomes in patients with Sjögren’s syndrome, including more miscarriages and intrauterine fetal deaths, preterm deliveries, small-for-gestational-age birthweight, and intrauterine growth retardation, as well as higher numbers of caesarean sections.”
To investigate the impact of Sjögren’s syndrome on pregnancy outcomes, de Frémont and colleagues conducted a multicenter, prospective study analyzing data from the GR2 registry, itself a multicenter, prospective, observational study database that was initiated in October 2014.
Patient data were included for those who conceived before March 2021 and had received a diagnosis of Sjögren’s syndrome according to the American College of Rheumatology and EULAR 2016 classification criteria. Patients were excluded from the analysis if they had “associated connective tissue diseases, rheumatoid arthritis, spondyloarthritis, or antiphospholipid syndrome,” the researchers wrote.
Information such as patients’ medical history, demographic data and laboratory findings were collected upon enrollment into GR2. During pregnancy, patient data were recorded at every follow-up visit. This information included EULAR Sjögren’s syndrome disease activity index (ESSDAI) score, laboratory results, ultrasound findings, any treatment changes and complications.
Adverse pregnancy outcomes were defined as “unexplained intrauterine fetal death after at least 12 weeks of gestation, neonatal death within the first 28 days of life, placental insufficiency leading to preterm birth and small-for-gestational-age birthweight,” the researchers wrote.
The analysis included a total of 106 pregnancies across 96 patients, with 93 pregnancies included at week 18 of gestation or earlier. Among those at 18 gestational weeks or earlier, disease flares occurred in 13%, according to the researchers.
Meanwhile, after excluding twins and medical terminations, a total of 88 pregnancies were analyzed for adverse pregnancy outcomes. Among these, adverse outcomes occurred in six cases (7%). According to the researchers, antiphospholipid antibody positivity appeared more common in patients in which adverse outcomes occurred. In the matched controlled study, adverse outcomes occurred in 9% of pregnancies among patients with Sjögren’s syndrome, and in 7% of the matched comparators.
“Our results show that pregnancies in women with primary Sjögren’s syndrome have very good prognoses for the mother and the fetus,” de Frémont and colleagues wrote. “No significantly increased adverse pregnancy outcome risk was observed compared with that of the general population.”
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