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Meta-Analysis
. 2018 Jun 7;18(1):212.
doi: 10.1186/s12884-018-1850-x.

Arterial/venous Thrombosis, Fetal Loss and Stillbirth in Pregnant Women With Systemic Lupus Erythematosus Versus Primary and Secondary Antiphospholipid Syndrome: A Systematic Review and Meta-Analysis

Affiliations
Free PMC article
Meta-Analysis

Arterial/venous Thrombosis, Fetal Loss and Stillbirth in Pregnant Women With Systemic Lupus Erythematosus Versus Primary and Secondary Antiphospholipid Syndrome: A Systematic Review and Meta-Analysis

Pravesh Kumar Bundhun et al. BMC Pregnancy Childbirth. .
Free PMC article

Abstract

Background: We aimed to systematically compare arterial/venous thrombosis, fetal loss and stillbirth in pregnant women with systemic lupus erythematosus (SLE), primary anti-phospholipid syndrome (PAPS) and secondary anti-phospholipid syndrome (SAPS).

Methods: Online databases were carefully searched for relevant publications comparing SLE with PAPS and/or SAPS in pregnancy. Studies were included if: they compared SLE with APS [SLE versus PAPS or SLE versus SAPS or SLE versus PAPS and SAPS respectively] in pregnant women; and they reported specific adverse outcomes as their clinical endpoints including arterial/venous thrombosis, fetal loss and stillbirth. Risk ratios (RR) with 95% confidence intervals (CIs) were used as statistical parameters and the analysis was carried out by the RevMan 5.3 software.

Results: A total number of 941 pregnant women were included: 556 were candidates of SLE; 200 were candidates of PAPS; and 185 were candidates of SAPS. APS was associated with a significantly higher risk of fetal loss (RR: 4.49, 95% CI: 2.09-9.64; P = 0.0001). In addition, stillbirth and arterial/venous thrombosis were also significantly increased with APS (RR: 6.65, 95% CI: 2.14-20.60; P = 0.001) and (RR: 3.95, 95% CI: 1.28-12.16; P = 0.02) respectively. When patients with PAPS were compared with patients who suffered from SLE alone, fetal loss and arterial/venous thrombosis were still significantly higher with the former. When SAPS were compared with SLE (without anti-phospholipid antibodies), arterial/venous thrombosis, stillbirth and fetal loss were still significantly higher with SAPS. However, no significant difference was observed in arterial/venous thrombosis and fetal loss between PAPS and SAPS.

Conclusions: PAPS and SAPS were associated with significantly higher arterial/venous thrombosis, fetal loss and stillbirth in comparison to SLE. However, no significant difference was observed when PAPS was compared to SAPS.

Keywords: Arterial thrombosis; Fetal loss; Pregnancy; Primary antiphospholipid syndrome; Secondary antiphospholipid syndrome; Stillbirth; Systemic lupus erythematosus; Venous thrombosis.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was not applicable for this systematic review and meta-analysis.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram showing the study selection
Fig. 2
Fig. 2
Adverse outcomes observed between APS and SLE during pregnancy
Fig. 3
Fig. 3
Arterial/Venous thrombosis observed between SLE and APS during pregnancy
Fig. 4
Fig. 4
Fetal loss observed between PAPS and SLE
Fig. 5
Fig. 5
Arterial/Venous thrombosis observed between PAPS and SLE during pregnancy
Fig. 6
Fig. 6
Adverse outcomes observed between SAPS and SLE during pregnancy (part 1)
Fig. 7
Fig. 7
Adverse outcomes observed between SAPS and SLE during pregnancy (part 2)
Fig. 8
Fig. 8
Arterial/Venous thrombosis observed between PAPS and SAPS during pregnancy
Fig. 9
Fig. 9
Fetal loss observed between PAPS and SAPS during pregnancy
Fig. 10
Fig. 10
Funnel plot showing publication bias (a)
Fig. 11
Fig. 11
Funnel plot showing publication bias (b)

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