BACKGROUND AND PURPOSE:

• Sjögren’s syndrome is an autoimmune disorder affecting lacrimal and salivary glands, resulting in dry eyes and mouth, and may be associated with other autoimmune disorders (e.g., SLE)
• De Frémont et al. (The Lancet Rheumatology, 2023) described adverse pregnancy, delivery, and birth outcome risks in pregnant women with primary Sjögren’s syndrome

METHODS:

• Multicenter, prospective, cohort study
  • French registry
  • GR2 cohort (Groupe de Recherche sur la Grossesse et les Maladies Rares)
• Participants
  • Ongoing pregnancy at 12 weeks
  • Matched controls from the general population
• Exposures
  • Diagnosed primary Sjögren’s syndrome
• Study design
  • The GR2 cohort was used to assess outcomes and risk factors for flares
  • Matched controls used to assess outcomes vs patients without Sjögren’s syndrome
  • Flares defined using European Alliance of Associations for Rheumatology (EULAR) Disease Activity Index (ESSDAI) scores
• Primary outcomes
  • Factors associated with primary Sjögren’s syndrome flare
    • ≥3-point increase in ESSDAI score
  • Factors associated with adverse pregnancy outcomes
    • Fetal or neonatal death | Placental insufficiency leading to a preterm delivery | Small-for-gestational-age
  • Pregnancy | Delivery | Birth outcome rates

RESULTS:

• 96 women with primary Sjögren’s syndrome | 106 pregnancies
  • Median age at pregnancy: 33 (IQR, 31 to 36) years
  • White women: 83% | Black women: 17%
  • Previous systemic activity (ESSDAI score of ≥1): 90%
  • Systemic activity at inclusion: 45%
• Incidence of primary Sjögren’s syndrome flares in pregnancy: 13%
  • No baseline parameters were associated with these flares
• Incidence of adverse pregnancy outcomes: 7%
• Among pregnancies in women with data for antiphospholipid antibodies, antiphospholipid antibody positivity was more frequent among pregnancies with adverse outcomes (P=0.023)
  • Adverse outcomes: 50% of 4 pregnancies
  • No adverse outcomes: 4% of 51 pregnancies
• In the matched controlled study, there was no significant difference in adverse pregnancy outcomes in women with primary Sjögren’s syndrome vs matched controls
  • Primary Sjögren’s syndrome: 9%
  • Controls: 7%
  • Odds ratio 1.31 (95% CI, 0.53 to 2.98) | P=0.52

CONCLUSION:

• Among women with primary Sjögren’s syndrome, pregnancy prognoses were generally good, and the odds of adverse outcomes were no higher than in the general population
• Women with antiphospholipid antibodies may be at higher risk, and should be monitored more closely

Learn More – Primary Sources:

Pregnancy outcomes in women with primary Sjögren’s syndrome: an analysis of data from the multicentre, prospective, GR2 study