妊娠中および妊娠後における重度の母性発症退役軍人における全身性白血病または関節リウマチ

Deirdre A Quinn¹, Florentina E Sileanu², Gregory T Procario²

¹Center for Healthcare Evaluation, Research, and Promotion, VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania.

ACR open rheumatology

|September 2, 2025

まとめ

システム性狼症 (SLE) やリウマチ性関節炎 (RA) の退役軍人は,重症母性疾患 (SMM) と妊娠中絶のリスクが高くなります. これらの高リスクグループには,VAシステム内の総合的な妊産婦ケアが推奨されています.

科学分野:

生殖健康
自己免疫疾患
医療サービス研究

背景:

システミック・ルプス・エリテマトーサス (SLE) とリウマチ性関節炎 (RA) は,妊娠の結果に影響を与える自己免疫疾患です.
退役軍人事務局 (VA) は,慢性的な自己免疫疾患を持つ退役軍人を含め,多くの退役軍人の医療サービスを提供しています.
これらの特殊な退役軍人の集団における重症妊産婦の死亡率 (SMM) を理解することは,標的を絞った医療介入にとって極めて重要です.

研究の目的:

システム性狼 (SLE) またはリウマチ性関節炎 (RA) と診断された妊婦退役軍人の重篤な母性疾患 (SMM) の発生率を決定する.
SLEまたはRAの退役軍人のSMM率を,これらの自己免疫疾患のない妊婦退役軍人のコホートと比較する.
退役軍人の医療システムにおける SLE と RA の退役軍人の妊娠結果の潜在的な格差を特定する.

主な方法:

2009年10月から2019年9月までのVA国家行政データの二次分析
妊娠前の少なくとも1回のVAプライマリケア訪問を持つ18~45歳の妊婦退役軍人を含む.
ICD-9/10コードを用いたSLE,RAおよび併発症の特定;CDCの定義に従って評価されたSMM.

主要な成果:

退役軍人29,713人のうち,SLEは113,RAは92人でした.
妊娠中絶率はSLEでは36%,RAでは30.4%で,他では25.2%でした.
SMMはSLE退役軍人の約10%とRA退役軍人の4.3%で,他の退役軍人の3.2%に比べて発生しました.

結論:

これはSLEとRAの退役軍人のSMMを調査した最初の研究です.
SLEの退役軍人はSMMのリスクが高く,SLEとRAのグループでは妊娠中絶率が高くなります.
退役軍人におけるSLEとRAの統合された妊産婦ケアモデルの必要性を支持しています.

さらに関連する動画

06:55

Assessment of Maternal Vascular Remodeling During Pregnancy in the Mouse Uterus

Published on: December 5, 2015

13.6K

08:50

A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development

Published on: June 24, 2020

3.9K

関連する概念動画

01:19

Mitral Valve Prolapse III: Nursing Management

The nursing management of Mitral Valve Prolapse, or MVP, centers around patient education, symptom monitoring, and lifestyle modifications.Patient Education on MVP Diagnosis and Heredity: Nurses should provide comprehensive education about MVP, a condition where the mitral valve does not close appropriately during heartbeats. This education often includes the condition's pathophysiology, symptoms, and potential complications, like arrhythmias or mitral regurgitation. Though not fully...

01:29

Pulmonary Tuberculosis I

321

Tuberculosis, often called TB, is a contagious illness primarily caused by Mycobacterium tuberculosis. It mainly affects the lung parenchyma but can also impact other body parts.
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...

321

01:20

Rheumatic Heart Disease IV: Nursing Management

AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...

01:23

Rheumatic Heart Disease I: Introduction

Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...

01:24

Disorders of the Female Reproductive System

487

The female reproductive system can be affected by several disorders, including Premenstrual Syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD), endometriosis, and various forms of cancer. PMS and PMDD are cyclical conditions that cause physical and emotional distress, with symptoms that include edema, mood swings, and food cravings. PMDD is a more severe form of PMS characterized by increased symptom severity that peaks during the luteal phase and tends to improve or resolve shortly after...

487

01:11

Genome-wide Association Studies-GWAS

14.1K

Genome-wide association studies or GWAS are used to identify whether common SNPs are associated with certain diseases. Suppose specific SNPs are more frequently observed in individuals with a particular disease than those without the disease. In that case, those SNPs are said to be associated with the disease. Chi-square analysis is performed to check the probability of the allele likely to be associated with the disease.
GWAS does not require the identification of the target gene involved in...