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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

Pravesh Kumar Bundhun  1 , Mohammad Zafooruddin Sani Soogund  2 , Feng Huang  3
Affiliations
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. .

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.

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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)
See this image and copyright information in PMC

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