Increased risk of systemic lupus erythematosus in pregnancy-induced hypertension

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Abstract

Dysregulation of the immune system plays a role in the pathogenesis of both, pregnancy-induced hypertension (PIH) and systemic lupus erythematosus (SLE). It is well known that SLE predisposes to be complicated with PIH. However, few studies have attempted to investigate whether PIH increased subsequent SLE risk.

The objectives of this study were to assess the association between PIH and subsequent SLE risk and identify predictive risk factors.

Patients with newly diagnosed PIH were selected from the Taiwan National Health Insurance Research Database (NHIRD) and compared with a matched cohort without PIH based on age and the year of delivery. The incidence of new-onset SLE was evaluated in both cohorts. The overall observational period was from January 1, 2000 to December 31, 2013.

Among the 23.3 million individuals registered in the NHIRD, 29,091 patients with PIH and 116,364 matched controls were identified. The incidence of SLE was higher among patients with PIH than in the matched controls (incidence rate ratio [IRR] = 4.02, 95% confidence interval [CI] 3.98–4.05, P < 0.0001). The IRR for subsequent SLE development remained significantly higher in all stratifications during the follow-up years. The multivariate Cox regression model was performed and the results showed that PIH may be an independent risk factors for the development of subsequent SLE (hazard ratio [HR] = 2.87, 95% CI 2.07–3.98, P < 0.0001). Moreover, multivariate Cox regression model was used again among the PIH cohort only in order to identify the possible risk factors for subsequent SLE in the population with PIH.

Patients with PIH may have higher risk of developing newly diagnosed SLE than those without PIH. In addition, among individuals who have experienced PIH, those younger than 30 years, having experienced preeclampsia/eclampsia, single parity, preterm birth, or chronic kidney disease, may display an increased subsequent risk of SLE.

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Pre-eclampsia part 1: current understanding of its pathophysiology.

Tinnakorn Chaiworapongsa, Piya Chaemsaithong, Lami Yeo … (2014)

Pre-eclampsia is characterized by new-onset hypertension and proteinuria at ≥20 weeks of gestation. In the absence of proteinuria, hypertension together with evidence of systemic disease (such as thrombocytopenia or elevated levels of liver transaminases) is required for diagnosis. This multisystemic disorder targets several organs, including the kidneys, liver and brain, and is a leading cause of maternal and perinatal morbidity and mortality. Glomeruloendotheliosis is considered to be a characteristic lesion of pre-eclampsia, but can also occur in healthy pregnant women. The placenta has an essential role in development of this disorder. Pathogenetic mechanisms implicated in pre-eclampsia include defective deep placentation, oxidative and endoplasmic reticulum stress, autoantibodies to type-1 angiotensin II receptor, platelet and thrombin activation, intravascular inflammation, endothelial dysfunction and the presence of an antiangiogenic state, among which an imbalance of angiogenesis has emerged as one of the most important factors. However, this imbalance is not specific to pre-eclampsia, as it also occurs in intrauterine growth restriction, fetal death, spontaneous preterm labour and maternal floor infarction (massive perivillous fibrin deposition). The severity and timing of the angiogenic imbalance, together with maternal susceptibility, might determine the clinical presentation of pre-eclampsia. This Review discusses the diagnosis, classification, clinical manifestations and putative pathogenetic mechanisms of pre-eclampsia.

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Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy.

Jennifer A Hutcheon, Sarka Lisonkova, K.S. Joseph (2011)

Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, pre-eclampsia and chronic hypertension with superimposed pre-eclampsia. Pre-eclampsia complicates about 3% of pregnancies, and all hypertensive disorders affect about five to 10% of pregnancies. Secular increases in chronic hypertension, gestational hypertension and pre-eclampsia have occurred as a result of changes in maternal characteristics (such as maternal age and pre-pregnancy weight), whereas declines in eclampsia have followed widespread antenatal care and use of prophylactic treatments (such as magnesium sulphate). Determinants of pre-eclampsia rates include a bewildering array of risk and protective factors, including familial factors, sperm exposure, maternal smoking, pre-existing medical conditions (such as hypertension, diabetes mellitus and anti-phospholipid syndrome), and miscellaneous ones such as plurality, older maternal age and obesity. Hypertensive disorders are associated with higher rates of maternal, fetal and infant mortality, and severe morbidity, especially in cases of severe pre-eclampsia, eclampsia and haemolysis, elevated liver enzymes and low platelets syndrome. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Pathogenesis of systemic lupus erythematosus.

Vincent Mok, Angel Lau, Mac Mok … (2003)

The exact patho-aetiology of systemic lupus erythematosus (SLE) remains elusive. An extremely complicated and multifactorial interaction among various genetic and environmental factors is probably involved. Multiple genes contribute to disease susceptibility. The interaction of sex, hormonal milieu, and the hypothalamo-pituitary-adrenal axis modifies this susceptibility and the clinical expression of the disease. Defective immune regulatory mechanisms, such as the clearance of apoptotic cells and immune complexes, are important contributors to the development of SLE. The loss of immune tolerance, increased antigenic load, excess T cell help, defective B cell suppression, and the shifting of T helper 1 (Th1) to Th2 immune responses leads to B cell hyperactivity and the production of pathogenic autoantibodies. Finally, certain environmental factors are probably required to trigger the disease.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: July 2016

Publication date (Electronic): 29 July 2016

Volume: 95

Issue: 30

Electronic Location Identifier: e4407

Affiliations

[a ]Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

[b ]Department of Biological Science, National Sun Yat-sen University, Kaohsiung, Taiwan

[c ]Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan

[d ]Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan

[e ]Department of Medical Research, China Medical University Hospital, Taichung, Taiwan

[f ]Department of Gastroenterology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

[g ]Section of Critical Care and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

[h ]Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

[i ]Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

[j ]School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Author notes

[∗ ]Correspondence: Li-Yu Hu, Pei-Ling Tang, Department of Psychiatry, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan (e-mail: chrishulygmail.com [L-YH]; Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan pltang728@ 123456gmail.com [P-LT] ).

Article

Accession ID: 04407

DOI: 10.1097/MD.0000000000004407

PMC ID: 5265875

PubMed ID: 27472738

SO-VID: 7734616f-084d-4a46-9af7-ea8976282f73

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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-nc-sa/4.0

History

Date received : 1 March 2016

Date revision received : 1 June 2016

Date accepted : 6 July 2016

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Keywords: eclampsia,hypertension in pregnancy,preeclampsia,pregnancy-induced hypertension,systemic lupus erythematosus

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Keywords: eclampsia, hypertension in pregnancy, preeclampsia, pregnancy-induced hypertension, systemic lupus erythematosus

Increased risk of systemic lupus erythematosus in pregnancy-induced hypertension : A nationwide population-based retrospective cohort study

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Most cited references 38

Pre-eclampsia part 1: current understanding of its pathophysiology.

Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy.

Pathogenesis of systemic lupus erythematosus.

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