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  • Title: [Analysis of adverse neonatal outcomes in pregnant women with positive anti-Ro/SSA and anti-La/SSB antibodies].
    Author: Zhang MY, Sun X.
    Journal: Zhonghua Fu Chan Ke Za Zhi; 2023 Nov 25; 58(11):804-810. PubMed ID: 37981765.
    Abstract:
    Objective: To investigate the relationship between positive anti-Ro/Sjögren syndrome antigen type A (SSA) antibody and anti-La/Sjögren syndrome antigen type B (SSB) antibody in pregnant women and neonatal adverse outcomes. Methods: This study was a retrospective study, and 145 deliveries of 136 anti-Ro/SSA and anti-La/SSB antibody positive pregnant women were selected who had prenatal examination and delivered in Peking University First Hospital from January 2017 to June 2022. According to whether adverse neonatal outcomes occurred, 145 deliveries were divided into adverse outcome group (26 cases) and no adverse outcome group (119 cases). According to the time when anti-Ro/SSA and anti-La/SSB antibodies were found positive, 145 deliveries were divided into the antibody positive during pregnancy group (69 cases) and the pre-pregnancy antibody positive group (76 cases). The pregnancy outcomes, treatment and maternal and infant antibody levels of pregnant women between the adverse outcome group and no adverse outcome group, between antibody positive during pregnancy group and the pre-pregnancy antibody positive group were compared. Results: (1) Most of the pregnant women with positive anti-Ro/SSA and anti-La/SSB antibodies were diagnosed as undifferentiated connective tissue disease, accounting for 40.4% (55/136), followed by Sjogren's syndrome (25.0%, 34/136), systemic lupus erythematosus (23.5%, 32/136), antiphospholipid antibody syndrome (6.6%, 9/136), idiopathic thrombocytopenic purpura (1.5%, 2/136), and 4 cases were not diagnosed. (2) The titers of anti-Ro/SSA and anti-La/SSB antibodies in the first trimester and the second trimester were compared, and there were no statistical significances (all P>0.05). (3) The proportion of high level anti-Ro/SSA antibody (>100 kU/L), positive level of anti-La/SSB antibody and positive rate of anti-La/SSB antibody in the adverse outcome group were higher than those in the no adverse outcome group, and the birth weight of newborns and live birth rate in the adverse outcome group were lower than that in the no adverse outcome group, all with statistical significances (all P<0.05). The anti-Ro/SSA antibody level, the proportion of drug treatment (hydroxychloroquine, glucocorticoid, gamma globulin), the incidence of fetal growth restriction (FGR), the rate of preterm birth, and the positive level of anti-Ro/SSA and anti-La/SSB antibodies in newborns were compared between the two groups, and there were no statistically significant differences (all P>0.05). (4) The anti-Ro/SSA antibody level of pregnant women in the pre-pregnancy antibody positive group, the proportion of hydroxychloroquine and glucocorticoid treatment, and the anti-Ro/SSA antibody positive rate of newborns were higher, while the incidence of FGR and gamma globulin treatment rate of newborns in the antibody positive during pregnancy group were higher, respectively, and the differences were statistically significant (all P<0.05). The levels of anti-La/SSB antibodies in pregnant women, anti-Ro/SSA and anti-La/SSB antibodies in newborns, the positive rate of anti-La/SSB antibodies in newborns and the incidence of adverse outcomes were compared between the antibody positive during pregnancy group and the pre-pregnancy antibody positive group, and there were no statistical significances (all P>0.05). Conclusions: High concentrations of anti-Ro/SSA antibodies and co-positive anti-La/SSB antibodies during pregnancy may increase the incidence of adverse neonatal outcomes. There is no significant difference in the incidence of adverse neonatal outcomes between antibody positive pregnant women and antibody positive pregnant women who were first found during pregnancy after comprehensive treatment in the rheumatology and immunology department. 目的： 探讨孕妇抗Ro/干燥综合征抗原A（SSA）抗体和（或）抗La/干燥综合征抗原B（SSB）抗体阳性与新生儿不良结局的关系。 方法： 本研究为回顾性研究，选取2017年1月至2022年6月于北京大学第一医院产前检查并分娩的抗Ro/SSA、抗La/SSB抗体阳性的136例孕妇的145例次分娩，根据是否发生新生儿不良结局将145例次分娩分为不良结局组（26例次）和无不良结局组（119例次），此外，根据发现抗Ro/SSA、抗La/SSB抗体阳性的时间将145例次分娩分为孕期阳性组（69例次）和孕前阳性组（76例次），分别比较不良结局组与无不良结局组、孕期阳性组与孕前阳性组孕妇的治疗、妊娠结局及母儿抗体水平。 结果： （1）136例抗Ro/SSA、抗La/SSB抗体阳性孕妇中，诊断为未分化结缔组织病者最多，占40.4%（55/136），其他依次为干燥综合征（25.0%，34/136）、系统性红斑狼疮（23.5%，32/136）、抗磷脂抗体综合征（6.6%，9/136）、特发性血小板减少性紫癜（1.5%，2/136），另有4例未行诊断。（2）41例妊娠期多次行抗体检测的孕妇中，妊娠早期与妊娠中期抗Ro/SSA、抗La/SSB抗体的水平分别比较，差异均无统计学意义（P均>0.05）。（3）不良结局组孕妇的抗Ro/SSA抗体高水平（>100 kU/L）比例、抗La/SSB抗体阳性孕妇的抗体水平及抗La/SSB抗体阳性率均高于无不良结局组，不良结局组的新生儿出生体重及活产率低于无不良结局组，分别比较，差异均有统计学意义（P均<0.05）。不良结局组与无不良结局组孕妇的抗Ro/SSA抗体水平、药物治疗（包括羟氯喹、糖皮质激素、丙种球蛋白）比例，胎儿生长受限（FGR）发生率、早产率及新生儿抗Ro/SSA、抗La/SSB抗体阳性率及抗体水平分别比较，差异均无统计学意义（P均>0.05）。（4）孕前阳性组孕妇抗Ro/SSA抗体水平，羟氯喹、糖皮质激素治疗比例，新生儿抗Ro/SSA抗体阳性率更高，而孕期阳性组FGR发生率、丙种球蛋白治疗率更高，分别比较，差异均有统计学意义（P均<0.05）。孕前阳性组与孕期阳性组孕妇的抗La/SSB抗体水平、新生儿抗Ro/SSA和抗La/SSB抗体水平、新生儿抗La/SSB抗体阳性率、不良结局发生率分别比较，差异均无统计学意义（P均>0.05）。 结论： 妊娠期抗Ro/SSA抗体高水平以及合并抗La/SSB抗体阳性可能会增加新生儿不良结局的发生。孕前抗Ro/SSA、抗La/SSB抗体阳性孕妇与妊娠期首次发现抗体阳性孕妇经风湿免疫科综合治疗后，新生儿不良结局的发生率无显著差异。.
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