SAFETY OF FERTILITY TREATMENTS IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS: DATA FROM A FRENCH PROSPECTIVE POPULATION-BASED STUDY
Notice bibliographique
Résumé
O063 / #228 Topic:AS21 - Pregnancy and Reproductive Health ABSTRACT CONCURRENT SESSION 11: PREGNANCY IN SLE 24-05-2025 10:40 AM - 11:40 AM Background/Purpose Fertility treatments, which involve the use of exogenous sex hormones, raise concerns about their safety in women with systemic lupus erythematosus (SLE). Methods This study included all pregnancies in women with SLE enrolled in the multicenter French prospective GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares, Clinicaltrial: NCT02450396 ) study, conceived before 1st August 2022, with available end-of-pregnancy data and known conception type.[1] Pregnancies were classified into 2 groups: those conceived naturally and those with assisted conception. Adverse pregnancy outcomes (APOs) were defined as the occurrence of an intrauterine fetal death after 12 weeks of gestation (WG), a placental insufficiency leading to preterm delivery before 37 WG, a small for gestational age, and/or a neonatal death.[1,2] Maternal flares were defined according to the SELENA-SLEDAI Flare Index. The main endpoint was the birth of a living child. Logistic regression was performed to assess whether fertility treatments were independently associated with live birth. Cumulative incidences of disease flares and APOs were also compared using Kaplan-Meier analysis (Cox regression model adjustment). Results 630 pregnancies met eligibility criteria, including 577 pregnancies obtained naturally in 478 women and 53 pregnancies through assisted conception (2 ovulation inductions, 12 intrauterine inseminations, and 39 in vitro fertilizations (IVF)) in 48 women. The mean age of women was older (35.8 vs. 32.3 years,p< 1.10^-4), and twins were more frequent in assisted pregnancies (5/50, 10.0% vs. 20/554, 3.6%;p= 0.047). Lupus disease was clinically inactive at baseline in 51/53 (96.2%) assisted pregnancies (vs 511/570, 89.6%;p= 0.15), with 10 of 45 (22.2%) having chronic damage (vs 65/513, 12.7%;p= 0.07). Lupus anticoagulant (LA) was present in 4/52 (7.7%) assisted pregnancies (vs 72/572, 12.6%;p= 0.38). Hydroxychloroquine was prescribed in 52/53 (98.1%) assisted pregnancies (vs 561/577, 97.2%;p= 1.0). About half of assisted and natural pregnancies (25/48, 52.1% vs 272/522, 52.1%;p= 1.0) were exposed to corticosteroids, but the daily prednisone dosage at inclusion was significantly higher in assisted pregnancies (median dose of 9 [IQR 5.0-10.0] vs. 5 [IQR 5.0-10.0] mg/day;p= 0.025). The live birth rate was similar between assisted and spontaneous pregnancies (46/53, 86.8% vs 505/577, 87.5%;p= 0.83). Assisted conception was not independently associated with achieving a live birth after adjusting for age, number of fetuses, gravidity, disease activity, damage, positive LA, exposure to low-dose aspirin, and daily prednisone dosage at inclusion (adjusted OR = 1.41 (95% CI 0.44-4.47),p= 0.56). At least one flare occurred in 9/53 (17.0%) assisted pregnancies (vs 96/565, 17.0%;p= 0.74). Among pregnancies progressing beyond 12 WG, at least one APO was reported in 8/48 (16.7%) assisted pregnancies (vs 86/525, 16.4%;p= 0.98). Cumulative incidences of flares, and APOs did not differ significantly between both groups. Fertility treatments did not appear to be an independent predictor of the occurrence of flare or APO after adjustment for confounding factors. When the analyses were limited to the group of pregnancies achieved by IVF, results remained unchanged. Conclusions Fertility treatments in women with mostly well-controlled SLE did not appear to increase risks of maternal and neonatal complications, supporting current recommendations.[3]References:[1.] Larosa M. Rheumatology (Oxford) 2022;keab943. [2.] Buyon JP. Ann Intern Med. 2015;163:153-63. [3.] Sammaritano LR. Arthritis Rheumatol 2020;72:529-56.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».