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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Las enfermedades reum&#225;ticas autoinmunes &#40;ERA&#41; se caracterizan por la disfunci&#243;n inmune&#44; la desregulaci&#243;n del complemento y la formaci&#243;n de autoanticuerpos pat&#243;genos<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">1-2</span></a>&#46; Predominan en mujeres&#44; suelen aparecer durante los a&#241;os reproductivos<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">3</span></a> y se asocian con un mayor riesgo de resultados adversos del embarazo o resultados obst&#233;tricos adversos &#40;ROA&#41;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">1-2</span></a>&#46; El lupus eritematoso sist&#233;mico &#40;LES&#41; es uno de los ERA m&#225;s estudiados en el embarazo&#46; Es bien sabido que las mujeres con LES que est&#225;n embarazadas tienen un mayor riesgo de ROA&#44; incluida la p&#233;rdida del feto&#44; la preeclampsia&#44; el parto prematuro&#44; la restricci&#243;n del crecimiento intrauterino &#40;RCIU&#41; o un tama&#241;o peque&#241;o para la edad gestacional &#40;PEG&#41;&#44; en comparaci&#243;n con la poblaci&#243;n general<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">4-9</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La enfermedad indiferenciada del tejido conectivo &#40;<span class="elsevierStyleItalic">undifferentiated connective tissue disease</span> &#91;UCTD&#93;&#41; es el t&#233;rmino utilizado para describir a las personas con s&#237;ntomas que sugieren una ERA que dura al menos tres a&#241;os y anticuerpos antinucleares positivos persistentes que no cumplen con los criterios establecidos para ninguna ERA<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">10</span></a>&#46; Por el contrario&#44; los embarazos con UCTD est&#225;n menos caracterizados y presentan hallazgos contradictorios&#46; Si bien algunos estudios sugieren un mayor riesgo de parto prematuro&#44; preeclampsia&#44; muerte fetal y PEG<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">11-12</span></a>&#44; otros han encontrado una tasa similar de ROA en comparaci&#243;n con controles de embarazo sin ERA y&#47;o de la poblaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">13-14</span></a>&#46; Una revisi&#243;n sistem&#225;tica reciente concluy&#243; que las personas con UCTD u otras enfermedades del tejido conectivo sin criterios tienen un mayor riesgo de ROA en comparaci&#243;n con los controles de embarazo sin ERA y&#47;o la poblaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A pesar de una asociaci&#243;n bien reconocida con ROA en personas con LES&#44; existe evidencia contradictoria sobre si esta relaci&#243;n tambi&#233;n existe en personas con UCTD&#46; Solo un estudio reciente ha comparado los resultados entre embarazos con LES y UCTD<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">14</span></a>&#46; Por lo tanto&#44; hemos llevado a cabo un estudio de cohorte retrospectivo de embarazos con LES y UCTD en el University College London Hospital &#40;UCLH&#41; para identificar si los resultados del embarazo son comparables entre personas con LES y UCTD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Hemos realizado un an&#225;lisis retrospectivo de todos los embarazos con LES y UCTD revisados en la UCLH de 2006 a 2019&#46; Todas las personas con LES deb&#237;an cumplir con los criterios del <span class="elsevierStyleItalic">American College of Rheumatology</span> &#40;ACR&#41; y del <span class="elsevierStyleItalic">Systemic Lupus Internacional Collaborating Clinics</span> &#40;SLICC&#41;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">16-17</span></a>&#46; Las personas con UCTD deb&#237;an tener s&#237;ntomas y positividad persistente de anticuerpos antinucleares en dos ocasiones distintas durante al menos tres a&#241;os y no cumplir con los criterios de ninguna otra ERA espec&#237;fica<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">10</span></a>&#46; Los ROA incluidos fueron&#58; preeclampsia &#40;hipertensi&#243;n de nueva aparici&#243;n despu&#233;s de las 20 semanas de gestaci&#243;n y proteinuria&#41;&#59; eclampsia &#40;convulsiones generalizadas en una paciente con preeclampsia&#41;&#59; s&#237;ndrome HELLP &#40;hem&#243;lisis&#44; enzimas hep&#225;ticas elevadas y recuento bajo de plaquetas&#41;&#59; parto prematuro &#40;&#60;<span class="elsevierStyleHsp" style=""></span>37 semanas&#41; de gestaci&#243;n&#59; aborto &#40;interrupci&#243;n del embarazo&#41;&#59; aborto espont&#225;neo &#40;&#60;<span class="elsevierStyleHsp" style=""></span>13 semanas de gestaci&#243;n&#41;&#59; p&#233;rdida del embarazo &#40;13-20 semanas&#41;&#59; muerte fetal &#40;&#62;<span class="elsevierStyleHsp" style=""></span>20 semanas de gestaci&#243;n&#41;&#59; restricci&#243;n del crecimiento intrauterino &#40;RCIU&#41;&#44; peque&#241;os para la edad gestacional &#40;PEG&#41; como aquellos beb&#233;s cuyo peso &#60;<span class="elsevierStyleHsp" style=""></span>percentil 10 para la edad gestacional&#59; desprendimiento de placenta &#40;separaci&#243;n prematura de la placenta desde el &#250;tero&#41;&#44; bloqueo cardiaco &#40;ralentizaci&#243;n o interrupci&#243;n de la se&#241;al el&#233;ctrica desde las c&#225;maras superiores del coraz&#243;n &#91;las aur&#237;culas&#93; hasta las c&#225;maras inferiores &#91;los ventr&#237;culos&#93;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Este es un estudio observacional retrospectivo de registros m&#233;dicos recopilados durante un periodo de m&#225;s de 30<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Todos los datos se derivaron del manejo cl&#237;nico normal y ning&#250;n paciente se someti&#243; a cuestionarios o procedimientos de investigaci&#243;n adicionales&#46; En este estudio no se presentan datos individualizados o identificables&#46; Por lo tanto&#44; no se requiri&#243; aprobaci&#243;n &#233;tica ni consentimiento informado&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Criterio de elegibilidad</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se incluyeron todas las personas revisadas en UCLH con registros completos de los resultados del embarazo hasta al menos cuatro semanas despu&#233;s del parto&#44; incluidas las mujeres que dieron a luz en otro lugar&#46; Se incluyeron personas con LES y ERA secundaria concomitante y pacientes con UCTD y un trastorno autoinmune espec&#237;fico de un &#243;rgano &#40;p&#46;ej&#46;&#44; enfermedad de Hashimoto o Addison&#41; o s&#237;ndrome antifosfol&#237;pido &#40;SAF&#41; con s&#237;ntomas y perfil autoinmune que el SAF no explica completamente&#46; Las personas con informaci&#243;n incompleta sobre el embarazo&#44; otros diagn&#243;sticos de ERA y embarazos m&#250;ltiples no se incluyeron en el an&#225;lisis final&#46; Tambi&#233;n excluimos a las personas con datos de seguimiento incompletos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Datos recopilados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Los datos recopilados incluyeron datos demogr&#225;ficos&#59; tabaquismo&#44; &#237;ndice de masa corporal&#44; fertilidad y si esos embarazos fueron planificados&#59; duraci&#243;n de la enfermedad&#59; comorbilidades&#44; que incluyen hipertensi&#243;n&#44; diabetes&#44; trastornos de la tiroides u otros trastornos autoinmunes&#59; ROA anterior y&#47;o actual &#40;aborto espont&#225;neo&#44; muerte fetal&#44; abortos&#44; parto prematuro&#44; restricci&#243;n del crecimiento intrauterino &#91;RCIU&#93;&#44; preeclampsia&#47;eclampsia&#47;s&#237;ndrome HELLP &#91;hem&#243;lisis&#44; enzimas hep&#225;ticas elevadas y plaquetas bajas&#93;&#44; desprendimiento de placenta&#44; bloqueo cardiaco cong&#233;nito &#91;BCC&#93; y otras anomal&#237;as cardiacas&#41;&#44; n&#250;mero de terminaciones y perfil de autoanticuerpos&#46; Las personas con LES se dividieron en 4 subgrupos&#58; mucocut&#225;neo y&#47;o articular&#59; renal&#59; neurol&#243;gico&#44; y hematol&#243;gico&#46; Tambi&#233;n analizamos informaci&#243;n sobre el &#250;ltimo embarazo&#44; incluida la actividad en el momento de la concepci&#243;n &#40;&#237;ndice del <span class="elsevierStyleItalic">British Isles Lupus Assessment Group</span> &#91;BILAG&#93;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">18</span></a> para pacientes con LES y evaluaci&#243;n global del m&#233;dico &#91;PGA&#93; para UCTD&#41;&#44; r&#233;gimen terap&#233;utico durante el embarazo&#44; brote de la enfermedad durante el embarazo &#40;PGA<span class="elsevierStyleHsp" style=""></span>0&#58; no-bajo nivel de actividad&#59; PGA<span class="elsevierStyleHsp" style=""></span>1&#58; actividad moderada&#47;severa&#41; y modo de parto &#40;vaginal o ces&#225;rea &#91;CS&#93;&#41;&#46; El brote de la enfermedad se defini&#243; como un cambio en las puntuaciones de actividad&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis de datos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se compararon los datos demogr&#225;ficos&#44; las caracter&#237;sticas de la enfermedad y los resultados en el &#250;ltimo embarazo en los grupos de LES y UCTD utilizando la prueba de chi-cuadrado de Pearson o la prueba exacta de Fisher para variables categ&#243;ricas y la prueba t de Student o la prueba de Mann-Whitney para variables num&#233;ricas&#44; seg&#250;n la distribuci&#243;n de la variable&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con IBM&#174; SPSS&#174; estad&#237;stica versi&#243;n 22&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Informaci&#243;n relacionada con el &#250;ltimo embarazo</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Caracter&#237;sticas demogr&#225;ficas y de la enfermedad</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se revisaron m&#225;s de 200 personas con LES o UCTD &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#59; despu&#233;s de las exclusiones&#44; se incluyeron un total de 71 &#40;51<span class="elsevierStyleHsp" style=""></span>LES y 20<span class="elsevierStyleHsp" style=""></span>UCTD&#41; para el an&#225;lisis del estudio&#46; Se identificaron diferencias significativas en la composici&#243;n &#233;tnica entre grupos&#46; La cohorte estaba formada predominantemente por poblaci&#243;n blanca &#40;LES &#91;47&#37;&#93;&#59; UCTD &#91;80&#37;&#93;&#41;&#44; asi&#225;tica en el LES &#40;28&#37;&#41; &#250;nicamente&#44; sin diferencias en poblaci&#243;n negra &#40;12&#37; frente al 10&#37;&#41; y otros antecedentes &#40;14&#37; frente al 10&#37;&#41; en LES y UCTD&#44; respectivamente&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">La edad materna en el momento de la concepci&#243;n&#44; la duraci&#243;n de la enfermedad&#44; los antecedentes de infertilidad y el &#237;ndice de masa corporal en su &#250;ltimo embarazo no fueron significativamente diferentes en el grupo de embarazadas con LES en comparaci&#243;n con los de los grupos de embarazadas con UCTD&#46; Se registraron datos sobre el tabaquismo en 66 de 71 pacientes&#44; y todos fueron reportados como no fumadores&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En el grupo de LES&#44; la afectaci&#243;n mucocut&#225;nea y&#47;o articular fue la m&#225;s com&#250;n &#40;77&#37;&#41;&#44; seguida de la nefritis l&#250;pica &#40;33&#37;&#41;&#46; La afectaci&#243;n neurol&#243;gica y hematol&#243;gica fue menos frecuente &#40;6&#37; cada subgrupo&#41;&#46; No se encontraron afectaciones cardiacas&#44; pulmonares u otras posibles afectaciones del LES &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">En el grupo de UCTD&#44; las principales caracter&#237;sticas identificadas fueron artralgia &#40;70&#37;&#41;&#44; erupci&#243;n cut&#225;nea &#40;35&#37;&#41; y enfermedad de Raynaud &#40;25&#37;&#41;&#44; seguidas de mialgia &#40;10&#37;&#41; y &#250;lceras bucales &#40;10&#37;&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Perfil autoinmune en el momento de la concepci&#243;n</span><p id="par0060" class="elsevierStylePara elsevierViewall">Los anticuerpos anti-ADNds y anti-Ro fueron significativamente mayores en el grupo de LES en comparaci&#243;n con el grupo de UCTD &#40;anti-ADNds 25&#37; frente al 0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014 &#47; anti-Ro 62&#37; frente al 25&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46; Los anticuerpos antinucleares &#40;ANA&#41;&#44; C3 &#43;&#47;&#8722; C4 bajo&#44; anti-La y anti-RNP mostraron una prevalencia similar entre los grupos&#46; Curiosamente&#44; tanto el LES como la UCTD tambi&#233;n presentaron resultados positivos comparables para los anticuerpos antifosfol&#237;pidos &#40;aPL&#41;&#44; incluidos el anticoagulante l&#250;pico&#44; la glicoprote&#237;na<span class="elsevierStyleHsp" style=""></span>I beta 2 y los anticuerpos anticardiolipina &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Comorbilidades</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se encontraron diversas comorbilidades&#44; incluidas hipertensi&#243;n&#44; diabetes mellitus&#44; trastornos de la tiroides&#44; s&#237;ndrome antifosfol&#237;pido &#40;SAF&#41; y otras enfermedades autoinmunes espec&#237;ficas de &#243;rganos&#46; Se observ&#243; una prevalencia significativamente mayor de trastornos de la tiroides en el grupo de UCTD en comparaci&#243;n con los embarazos con LES &#40;20&#37; frente al 4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#46; Sin embargo&#44; no se identificaron diferencias en la frecuencia de otras comorbilidades &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Medicaci&#243;n durante el embarazo</span><p id="par0070" class="elsevierStylePara elsevierViewall">Hidroxicloroquina &#40;HCQ&#41; en dosis entre 100-400<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; esteroides en dosis bajas &#40;&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; y dosis altas &#40;&#62;<span class="elsevierStyleHsp" style=""></span>7&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y dosis bajas &#40;&#62;<span class="elsevierStyleHsp" style=""></span>7&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#46; La aspirina dosis bajas &#40;<span class="elsevierStyleItalic">low-dose aspirin</span> &#91;LDA&#93;&#41; de 75<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41; se prescribi&#243; con mayor frecuencia en el LES en comparaci&#243;n con los embarazos con UCTD &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; En contraste&#44; no hubo diferencias en el uso de azatioprina &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;063&#41;&#44; inhibidores de la calcineurina &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;554&#41; y heparina de bajo peso molecular &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;204&#41; entre los grupos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Planificaci&#243;n del embarazo&#44; actividad de la enfermedad en el momento de la concepci&#243;n y exacerbaci&#243;n durante el embarazo o el posparto</span><p id="par0075" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los embarazos con LES y UCTD fueron planificados &#40;81&#37; frente al 77&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;732&#41; y ten&#237;an la enfermedad inactiva &#40;96&#37; frente al 89&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;296&#41; en el momento de la concepci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Hubo un porcentaje similar de brotes de la enfermedad durante el embarazo y&#47;o puerperio &#40;14&#37; vs 10&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;000&#41; en los embarazos con LES y UCTD &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Resultados del embarazo &#40;durante su &#250;ltimo embarazo&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los embarazos resultaron en beb&#233;s nacidos vivos&#44; con el 96&#37; en el grupo LES y el 100&#37; en el grupo UCTD&#44; sin diferencias significativas entre grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;000&#41;&#46; No hubo diferencias significativas en ROA entre los embarazos con LES y UCTD &#40;16&#37; vs 5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;429&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Historial del n&#250;mero de embarazos y resultados adversos del embarazo en pacientes con LES y UCTD</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se encontr&#243; que los antecedentes obst&#233;tricos eran similares entre los embarazos con LES y UCTD&#44; sin diferencias en el n&#250;mero de embarazos previos&#44; abortos espont&#225;neos&#44; muerte fetal&#44; abortos&#44; parto prematuro&#44; RCIU&#44; preeclampsia&#47;eclampsia&#47;s&#237;ndrome HELLP&#44; desprendimiento de placenta y BBC u otros trastornos card&#237;acos &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Comparaci&#243;n de los resultados de BCC y anomal&#237;as cardiacas en pacientes con anticuerpos anti-Ro positivos&#44; LES y UCTD</span><p id="par0090" class="elsevierStylePara elsevierViewall">Realizamos un suban&#225;lisis para pacientes con LES y UCTD que dieron positivo en anticuerpos anti-Ro &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41; para identificar si alguno de ellos ten&#237;a m&#225;s probabilidades de sufrir BCC y otras anomal&#237;as cardiacas&#46; No se identificaron diferencias significativas en t&#233;rminos de estas complicaciones fetales cuando se compararon los embarazos con UCTD y LES &#40;40&#37; vs 9&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;132&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Encontramos una prevalencia comparable de ROA entre embarazos con LES y UCTD&#46; Se han publicado pocos estudios que examinen ROA en embarazos con LES<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">6-8</span></a> o UCTD<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">11-13</span></a>&#44; y actualmente solo est&#225; disponible un estudio que compare los resultados gestacionales en embarazos con LES y UCTD<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Es bien sabido que el origen &#233;tnico juega un papel clave en la patog&#233;nesis del LES&#44; y se encontr&#243; que las personas de etnia negra y asi&#225;tica tienen una enfermedad m&#225;s grave<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">19-20</span></a>&#46; Nuestra cohorte estaba formada predominantemente por mujeres embarazadas blancas con LES y UCTD&#46; Aunque se encontr&#243; una prevalencia significativamente mayor en personas de origen asi&#225;tico en el LES en comparaci&#243;n con los embarazos con UCTD&#44; no se observaron diferencias en el ROA&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Para evaluar el riesgo de desarrollar complicaciones obst&#233;tricas&#44; a las personas con LES y otras con ERA se les realiza pruebas de rutina para detectar diferentes anticuerpos y otras mol&#233;culas inmunol&#243;gicas&#46; Los niveles bajos de complemento&#44; la positividad de anticuerpos anti-ADNds&#44; aPL y&#47;o anti-ENA se han asociado con una mayor tasa de complicaciones del embarazo en LES<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">4&#44;21&#44;22</span></a> y UCTD<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">13&#44;23</span></a>&#46; Nuestra cohorte tuvo niveles significativamente m&#225;s altos de anti-ADNds y anticuerpos anti-Ro positivos en el grupo de LES en comparaci&#243;n con los embarazos con UCTD&#46; Sin embargo&#44; este desequilibrio entre los dos grupos no condujo a una diferencia en ROA&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Tambi&#233;n encontramos que 5&#47;71 personas hab&#237;an dado a luz a beb&#233;s con BCC&#46; Las personas con anticuerpos anti-Ro positivos pueden desarrollar malos resultados en el embarazo&#44; incluido lupus neonatal o BCC en el beb&#233;&#46; La prevalencia de BCC se estima en alrededor del 1-2&#37;&#44; que aumenta al 18&#37; en embarazos posteriores en aquellas que previamente tuvieron un beb&#233; con BCC<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">24-25</span></a>&#46; Adem&#225;s&#44; algunos estudios han demostrado que las personas con UCTD que ten&#237;an anticuerpos anti-Ro positivos ten&#237;an m&#225;s probabilidades de tener embarazos complicados por BCC que las personas con LES y anticuerpos anti-Ro<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">24&#44;26</span></a>&#46; Sin embargo&#44; estas diferencias pueden deberse a la heterogeneidad cl&#237;nica de los pacientes reclutados en estos estudios<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">26</span></a>&#46; Por lo tanto&#44; llevamos a cabo un suban&#225;lisis de personas con positividad de anticuerpos anti-Ro en embarazos con UCTD y LES &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Encontramos que&#44; aunque los anticuerpos anti-Ro fueron m&#225;s prevalentes en el LES en comparaci&#243;n con los embarazos con UCTD &#40;62&#37; frente al 25&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#44; no hubo diferencias significativas en la BCC entre ambos grupos &#40;40&#37; frente al 9&#44;7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;132&#41;&#46; Este hallazgo puede explicarse por el mayor uso de HCQ en embarazos con LES&#44; ya que se sabe que este f&#225;rmaco previene la BCC posterior en madres anti-Ro positivas con embarazos previamente afectados<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">27</span></a>&#46; Otras posibles explicaciones incluyen el peque&#241;o tama&#241;o de la muestra en el grupo UCTD y la diferente prevalencia de los subtipos anti-Ro que no pudimos evaluar en este estudio<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Otros autoanticuerpos que causan ROA son los aPL que se encuentran en el SAF y otros ERA&#44; principalmente LES con una prevalencia estimada del 30-40&#37;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">29-30</span></a>&#46; Estos anticuerpos confieren un mayor riesgo de complicaciones gestacionales&#44; incluido el parto prematuro&#44; la preeclampsia o los abortos espont&#225;neos<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">4&#44;31&#44;32</span></a>&#46; Curiosamente&#44; la prevalencia de anticuerpos aPL en nuestra cohorte fue baja y similar entre ambos grupos&#46; Estas cifras son comparables al art&#237;culo de Kaufman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">14</span></a> sobre embarazos con LES y UCTD&#46; Los bajos niveles de positividad de aPL encontrados en nuestra cohorte pueden haber contribuido a las tasas m&#225;s bajas de ROA identificadas&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Se observ&#243; un porcentaje similar de brotes de la enfermedad durante el embarazo y&#47;o el puerperio en los embarazos con LES y UCTD&#46; Las diferencias en el uso de medicamentos podr&#237;an explicar este hecho&#46; La HCQ se utiliza con frecuencia para tratar la ERA&#44; que se ha estudiado ampliamente durante el embarazo para reducir el riesgo de exacerbaciones de la enfermedad en los embarazos con LES<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">33-34</span></a>&#46; Adem&#225;s&#44; tambi&#233;n se ha demostrado que la HCQ en embarazos anti-Ro positivos reduce la recurrencia de BCC en embarazos posteriores<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">27</span></a>&#46; Descubrimos que se produjo un mayor uso de HCQ en el LES en comparaci&#243;n con los embarazos con UCTD&#44; lo que puede haber contribuido a los bajos niveles de actividad de la enfermedad y las tasas de ROA en los embarazos con LES&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Las diferencias en los reg&#237;menes de tratamiento entre los grupos pueden haber contribuido a tasas similares de ROA&#46; Los corticosteroides son el f&#225;rmaco de elecci&#243;n para suprimir los brotes de LES durante el embarazo<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">35-36</span></a>&#46; Tambi&#233;n informamos una administraci&#243;n significativamente mayor en LES en comparaci&#243;n con UCTD&#46; La aspirina en dosis bajas &#40;LDA&#41; es un antiagregante que se administra preferiblemente antes de las 16 semanas y se prescribe en personas con LES de alto riesgo&#44; perfil de aPL de alto riesgo y pacientes con SAF para reducir las posibilidades de ROA&#44; como parto prematuro y preeclampsia grave<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">37</span></a>&#46; Se observ&#243; que a nuestro grupo con LES tambi&#233;n se le prescribi&#243; LDA de manera m&#225;s significativa en comparaci&#243;n con los pacientes con UCTD&#46; No encontramos diferencias entre los grupos con otros tratamientos considerados seguros de usar durante el embarazo&#44; como la azatioprina&#44; los inhibidores de la calcineurina o la heparina de bajo peso molecular&#46; La raz&#243;n de esto puede estar relacionada con el n&#250;mero limitado de pacientes analizados&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En resumen&#44; se descubri&#243; que nuestros pacientes con LES fueron tratados significativamente con m&#225;s HCQ&#44; esteroides y LDA en comparaci&#243;n con los pacientes con UCTD&#44; lo que podr&#237;a ser la raz&#243;n principal por la que se observ&#243; que nuestros pacientes con LES ten&#237;an menos incidencias de ROA que los casos informados anteriormente en la literatura y similar a los pacientes con UCTD&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Los factores cardiovasculares tambi&#233;n pueden influir en el curso de los embarazos en pacientes con ERA<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">38</span></a>&#46; No observamos diferencias entre ambos grupos en cuanto a hipertensi&#243;n o diabetes preexistentes&#46; Sin embargo&#44; encontramos que los trastornos de la tiroides ocurr&#237;an significativamente con mayor frecuencia en pacientes con UCTD en comparaci&#243;n con embarazos con LES &#40;20&#37; frente al 4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#46; Se han encontrado previamente trastornos de la tiroides en nuestra cohorte de LES en la UCLH&#44; donde el 5&#44;2&#37; ten&#237;an hipotiroidismo y el 1&#44;4&#37;&#44; hipertiroidismo<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">39</span></a>&#46; Danieli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">40</span></a> tambi&#233;n encontraron tasas similares de trastornos de la tiroides &#40;6&#44;6&#37;&#41; en pacientes con UCTD&#46; A pesar de algunos art&#237;culos que describen el perfil autoinmune de la tiroides en mujeres embarazadas con UCTD<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">41</span></a>&#44; no encontramos art&#237;culos que describan esta mayor prevalencia en mujeres embarazadas con UCTD&#44; lo que requiere m&#225;s investigaci&#243;n&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Los resultados que muestran que los embarazos con LES y UCTD tuvieron tasas similares de ROA durante su &#250;ltimo embarazo concuerdan con los hallazgos informados por Kaufman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">14</span></a>&#46; Sin embargo&#44; informaron que el porcentaje de ROA era significativamente mayor en los embarazos con LES con enfermedad activa&#46; Por lo tanto&#44; la explicaci&#243;n probable de por qu&#233; no encontramos diferencias similares entre ambos grupos es que la mayor&#237;a de nuestros embarazos con LES fueron planificados previamente donde se observ&#243; que la actividad de la enfermedad era inactiva&#47;estable en el momento de la concepci&#243;n&#44; donde los principales s&#237;ntomas de LES presentados inclu&#237;an afectaci&#243;n articular mucocut&#225;nea y articular que hab&#237;a sido tratada con HCQ &#43;&#47;&#8722; LDA &#43;&#47;&#8722; esteroides&#46;</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Limitaciones del estudio</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los datos para este estudio se recopilaron retrospectivamente a partir de evaluaciones cl&#237;nicas obtenidas durante las citas de rutina&#46; Falta informaci&#243;n sobre otros autoanticuerpos&#44; como los subtipos anti-Ro&#44; que pueden ser relevantes para identificar asociaciones con ROA&#46; Nuestros hallazgos tambi&#233;n est&#225;n limitados por el peque&#241;o tama&#241;o de la muestra general&#44; especialmente en el n&#250;mero de pacientes con UCTD&#44; as&#237; como por la falta de un grupo de control de embarazo saludable&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusiones</span><p id="par0150" class="elsevierStylePara elsevierViewall">Encontramos una prevalencia similar de ROA entre los embarazos con LES y UCTD&#46; La baja prevalencia de complicaciones del embarazo que se produjeron en nuestro grupo de LES en comparaci&#243;n con otros estudios publicados probablemente se explique por el hecho de que la mayor&#237;a de nuestros embarazos con LES fueron planificados&#44; las pacientes ten&#237;an una actividad estable de la enfermedad en el momento de la concepci&#243;n y las pacientes tambi&#233;n fueron tratadas adecuadamente con tratamientos seguros incluyendo HCQ &#43;&#47;&#8722; LDA &#43;&#47;&#8722; esteroides durante sus embarazos&#46; Por lo tanto&#44; se destaca la importancia y la necesidad de continuar con el uso de medicamentos seguros durante los embarazos para mejorar las posibilidades de que las pacientes conciban y den a luz beb&#233;s sanos&#46; Identificamos tasas similares de HBC a pesar de una menor prevalencia de anticuerpos anti-Ro en embarazos con UCTD&#44; lo que resalta la importancia de las pruebas de rutina de estos anticuerpos particulares durante el asesoramiento previo al embarazo de personas con UCTD&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Financiaci&#243;n</span><p id="par0155" class="elsevierStylePara elsevierViewall">CM recibi&#243; el apoyo de la Beca de Investigaci&#243;n de la Fundaci&#243;n para el Desarrollo de la Medicina Interna en Europa &#40;FDIME&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">CM recibi&#243; el apoyo de la Fundaci&#243;n Alfonso Mart&#237;n Escudero&#44; Espa&#241;a&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">CM recibi&#243; apoyo de Lupus UK&#44; Reino Unido&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores informan que carecen de conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las mujeres con lupus eritematoso sist&#233;mico &#40;LES&#41; presentan un riesgo elevado de resultados obst&#233;tricos adversos &#40;ROA&#41;&#46; Sin embargo&#44; la evidencia cient&#237;fica es inconclusa si este riesgo tambi&#233;n existe en pacientes con enfermedad del tejido conectivo no diferenciada &#40;UCTD&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Realizamos una revisi&#243;n retrospectiva &#40;2006-2019&#41; de los resultados del embarazo entre pacientes con LES &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41; y UCTD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#46; Examinamos la ocurrencia de varios ROA&#58; aborto espont&#225;neo&#44; mortinato&#44; terminaci&#243;n&#44; parto prematuro&#44; preeclampsia&#44; eclampsia&#44; s&#237;ndrome HELLP&#44; restricci&#243;n del crecimiento intrauterino&#44; desprendimiento de placenta&#44; bloqueo card&#237;aco cong&#233;nito u otras anomal&#237;as card&#237;acas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La edad media en el embarazo fue de 35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;0 a&#241;os para pacientes con LES y 35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;8 a&#241;os para UCTD &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;349&#41;&#46; La proporci&#243;n de mujeres cauc&#225;sicas fue del 47&#37; en LES y del 80&#37; en UCTD&#46; Los embarazos fueron mayoritariamente planificados &#40;81&#37; en LES y 77&#37; en UCTD&#41;&#44; y la enfermedad inactiva en la concepci&#243;n &#40;96&#37; en LES y 89&#37; en UCTD&#41;&#46; La hidroxicloroquina en la concepci&#243;n fue utilizada por el 86&#37; en pacientes con LES vs&#46; el 36&#37; en UCTD&#46; Tanto las cohortes de LES como de UCTD presentaron tasas bajas de brotes de la enfermedad durante el embarazo y&#47;o el puerperio &#40;14&#37; vs 10&#37;&#41;&#46; La incidencia de ROA fue del 15&#44;6&#37; en LES vs&#46; el 5&#37; en UCTD &#40;diferencia de riesgo 19&#44;5&#37;&#59; intervalo de confianza del 95&#37;&#58; &#8722;3&#44;9 a 43&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;4237&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio subraya la importancia de una correcta planificaci&#243;n y el mantenimiento del tratamiento adecuado durante el embarazo para minimizar el riesgo de ROA en ambos grupos&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Females diagnosed with systemic lupus erythematosus &#40;SLE&#41; face an elevated risk of adverse pregnancy outcomes &#40;APOs&#41;&#46; However&#44; the evidence regarding whether a similar association exists in patients with undifferentiated connective tissue disease &#40;UCTD&#41; is inconclusive&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We conducted a retrospective review &#40;2006-2019&#41; of pregnancy outcomes among patients with SLE &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41; and UCTD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41; within our institution&#46; We examined the occurrence of various APOs&#44; encompassing miscarriage&#44; stillbirth&#44; termination&#44; preterm birth&#44; pre-eclampsia&#44; eclampsia&#44; HELLP syndrome&#44; intrauterine growth restriction&#44; abruption placentae&#44; congenital heart block&#44; or other cardiac abnormalities&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The mean age at pregnancy was 35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;0 years for patients with SLE and 35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;8 years for those with UCTD &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;349&#41;&#46; The proportion of Caucasian women was 47&#37; in SLE and 80&#37; in UCTD&#46; Pregnancies in both groups were planned &#40;81&#37; in SLE and 77&#37; in UCTD&#41;&#44; and patients presented with inactive disease at conception &#40;96&#37; in SLE and 89&#37; in UCTD&#41;&#46; Hydroxychloroquine at conception was utilized by 86&#37; of women with SLE&#44; in contrast to 36&#37; in the UCTD group&#46; Both&#44; SLE and UCTD cohorts exhibited low rates of disease flares during pregnancy and&#47;or puerperium &#40;14&#37; vs&#46; 10&#37;&#41;&#46; The incidence of APOs was 15&#46;6&#37; in SLE patients compared to 5&#37; in those with UCTD &#40;Risk difference 19&#46;5&#37;&#59; 95&#37; confidence interval&#58; &#8722;3&#46;9 to 43&#46;1&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;4237&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Our study underscores the importance of strategic pregnancy planning and the maintenance of appropriate treatment throughout pregnancy to ensure optimal disease management and minimize adverse outcomes in both SLE and UCTD pregnancies&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Abreviatura&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Definici&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">LES&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Patients who fulfil American College of Rheumatology and Systemic Lupus Collaborating Clinics classification criteria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">U-ERA &#40;<span class="elsevierStyleItalic">UARD en ingl&#233;s</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Pacientes con signos y s&#237;ntomas sugestivos de una enfermedad reum&#225;tica autoinmune &#40;ERA&#41; pero que no cumplen con los criterios para una ERA definida&#44; que dura al menos tres a&#241;os y positividad persistente de anticuerpos antinucleares en dos ocasiones distintas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">ROA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Los resultados adversos del embarazo incluidos fueron&#58; preeclampsia &#40;hipertensi&#243;n de nueva aparici&#243;n despu&#233;s de las 20 semanas de gestaci&#243;n y proteinuria&#41;&#59; eclampsia &#40;convulsiones generalizadas en una paciente con preeclampsia&#41;&#59; s&#237;ndrome HELLP &#40;hem&#243;lisis&#44; enzimas hep&#225;ticas elevadas y recuento bajo de plaquetas&#41;&#59; parto prematuro &#40;&#60;<span class="elsevierStyleHsp" style=""></span>37 semanas&#41; de gestaci&#243;n&#59; interrupci&#243;n &#40;interrupci&#243;n del embarazo&#41;&#59; aborto espont&#225;neo &#40;&#60;<span class="elsevierStyleHsp" style=""></span>13 semanas de gestaci&#243;n&#41;&#59; embarazo p&#233;rdida &#40;13-20 semanas&#41;&#59; muerte fetal &#40;&#62;<span class="elsevierStyleHsp" style=""></span>20 semanas de gestaci&#243;n&#41;&#59; restricci&#243;n del crecimiento intrauterino &#40;RCIU&#41;&#44; peque&#241;os para la edad gestacional &#40;PEG&#41;&#44; como aquellos beb&#233;s cuyo peso &#60;<span class="elsevierStyleHsp" style=""></span>percentil 10 para la edad gestacional&#44; desprendimiento de placenta &#40;separaci&#243;n prematura de la placenta del &#250;tero&#41;&#44; bloqueo card&#237;aco &#40;ralentizaci&#243;n o interrupci&#243;n de la se&#241;al el&#233;ctrica desde las c&#225;maras superiores del coraz&#243;n &#91;las aur&#237;culas&#93; a las c&#225;maras inferiores &#91;los ventr&#237;culos&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Actividad de la enfermedad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">La actividad en el momento de la concepci&#243;n se evalu&#243; con el &#237;ndice del Grupo de Evaluaci&#243;n del Lupus de las Islas Brit&#225;nicas &#40;BILAG&#41; para pacientes con LES y la evaluaci&#243;n global del m&#233;dico &#40;PGA&#41; para UCTD&#46;La presencia de exacerbaci&#243;n de la enfermedad durante el embarazo se evalu&#243; en ambos grupos mediante PGA &#40;PGA 0&#58; actividad sin baja&#59; PGA 1&#58; actividad moderada&#47;severa&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;037&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asi&#225;tico&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35 &#40;7&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35 &#40;6&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;349&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;0 &#40;11&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;060&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de masa corporal&#44; mediana &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;8 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;6 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fumadora&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Afectaci&#243;n de &#243;rganos del LES&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucocut&#225;nea y&#47;o articular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neurol&#243;gica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hematol&#243;gica &#40;AIHA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Caracter&#237;sticas de UCTD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Artralgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Erupci&#243;n cut&#225;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Raynaud&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mialgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#218;lceras en la boca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Serolog&#237;a en parto&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ANA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C3 y&#47;o C4 bajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-ADNbc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-Ro&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-La&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-RNP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lupus anticoagulante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anticardiolipina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-beta 2 glicoprote&#237;na&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;ndrome antifosfol&#237;pido&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Otras enfermedades autoinmunes&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Diabetes&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Trastornos de la tiroides&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento durante el embarazo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hidroxicloroquina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Esteroides&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804; 7&#44;5<span class="elsevierStyleHsp" style=""></span>mg prednisolona&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 7&#44;5<span class="elsevierStyleHsp" style=""></span>mg prednisolona&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Azatioprina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inhibidores de calcineurina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aspirina de dosis baja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;026&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heparina de bajo peso molecular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;204&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Enfermedad activa en el momento de la concepci&#243;n&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Embarazo planificado&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;77&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Historia de infertilidad&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;200&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Brote de la enfermedad durante el &#250;ltimo embarazo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Durante&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Posparto&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parto prematuro&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Restricci&#243;n del crecimiento intrauterino&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Preeclampsia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aborto espont&#225;neo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LESn<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UCTDn<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Embarazos&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;332&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Historia de resultados obst&#233;tricos adversos&#44; n &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;951&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aborto espont&#225;neo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;647&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muerte fetal&#47;mortinato&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aborto&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parto prematuro&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;714&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Preeclampsia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;668&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eclampsia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;282&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome de HELLP&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Restricci&#243;n del crecimiento intrauterino&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desprendimiento de la placenta&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;282&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BCC u otras anomal&#237;as cardiacas&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;616&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#44;0&#37;&nbsp;\t\t\t\t\t\t\n
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Vol. 224. Núm. 6.
Páginas 357-365 (junio - julio 2024)
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Vol. 224. Núm. 6.
Páginas 357-365 (junio - julio 2024)
Original
Comparativa de resultados obstétricos en pacientes con lupus eritematoso sistémico (LES) y enfermedad indiferenciada del tejido conectivo (UCTD): un estudio de cohorte descriptivo
Comparing pregnancy outcomes in patients with systemic lupus erythematosus (SLE) and undifferentiated connective tissue disease (UCTD): a descriptive cohort study
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C. Muñoz Muñoza,b,
Autor para correspondencia
drcandidomunoz@gmail.com

Autor para correspondencia.
, F. Farinhaa,c, T. McDonnelld, H. Jbaria, H. Nguyena, D. Isenberga, A. Rahmana, D. Williamse, J. Alijotas-Reigb, I. Gilesa
a Centro de Reumatología, División de Medicina, University College London, Londres, Reino Unido
b Unidad de Enfermedades Autoinmunes Sistémicas, Departamento de Medicina, Hospital Universitario Vall d’Hebron, Barcelona, España
c Reumatología, Hospital Distrital de Santarém, Santarém, Portugal
d Departamento de Ingeniería Bioquímica, University College London, Londres, Reino Unido
e Women's Health, University College London Hospital NHS Foundation Trust, Londres, Reino Unido
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Estadísticas
Figuras (1)
Tablas (4)
Tabla 1. Definiciones y abreviaturas
Tabla 2. Características de la enfermedad, variables iniciales y resultados del embarazo (en el momento del último embarazo) en pacientes con LES y UCTD
Tabla 3. Resultados obstétricos anteriores en pacientes con LES y UCTD
Tabla 4. BCC u otras anomalías cardiacas (incluyendo solo pacientes con anti-Ro positivo)
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Resumen
Introducción

Las mujeres con lupus eritematoso sistémico (LES) presentan un riesgo elevado de resultados obstétricos adversos (ROA). Sin embargo, la evidencia científica es inconclusa si este riesgo también existe en pacientes con enfermedad del tejido conectivo no diferenciada (UCTD).

Métodos

Realizamos una revisión retrospectiva (2006-2019) de los resultados del embarazo entre pacientes con LES (n=51) y UCTD (n=20. Examinamos la ocurrencia de varios ROA: aborto espontáneo, mortinato, terminación, parto prematuro, preeclampsia, eclampsia, síndrome HELLP, restricción del crecimiento intrauterino, desprendimiento de placenta, bloqueo cardíaco congénito u otras anomalías cardíacas.

Resultados

La edad media en el embarazo fue de 35±7,0 años para pacientes con LES y 35±6,8 años para UCTD (p=0,349). La proporción de mujeres caucásicas fue del 47% en LES y del 80% en UCTD. Los embarazos fueron mayoritariamente planificados (81% en LES y 77% en UCTD), y la enfermedad inactiva en la concepción (96% en LES y 89% en UCTD). La hidroxicloroquina en la concepción fue utilizada por el 86% en pacientes con LES vs. el 36% en UCTD. Tanto las cohortes de LES como de UCTD presentaron tasas bajas de brotes de la enfermedad durante el embarazo y/o el puerperio (14% vs 10%). La incidencia de ROA fue del 15,6% en LES vs. el 5% en UCTD (diferencia de riesgo 19,5%; intervalo de confianza del 95%: −3,9 a 43,1; p=0,4237).

Conclusión

Nuestro estudio subraya la importancia de una correcta planificación y el mantenimiento del tratamiento adecuado durante el embarazo para minimizar el riesgo de ROA en ambos grupos.

Palabras clave:
Resultados adversos del embarazo
Enfermedad del tejido conectivo indiferenciado
Lupus eritematoso sistémico
Abstract
Background

Females diagnosed with systemic lupus erythematosus (SLE) face an elevated risk of adverse pregnancy outcomes (APOs). However, the evidence regarding whether a similar association exists in patients with undifferentiated connective tissue disease (UCTD) is inconclusive.

Methods

We conducted a retrospective review (2006-2019) of pregnancy outcomes among patients with SLE (n=51) and UCTD (n=20) within our institution. We examined the occurrence of various APOs, encompassing miscarriage, stillbirth, termination, preterm birth, pre-eclampsia, eclampsia, HELLP syndrome, intrauterine growth restriction, abruption placentae, congenital heart block, or other cardiac abnormalities.

Results

The mean age at pregnancy was 35±7.0 years for patients with SLE and 35±6.8 years for those with UCTD (P=.349). The proportion of Caucasian women was 47% in SLE and 80% in UCTD. Pregnancies in both groups were planned (81% in SLE and 77% in UCTD), and patients presented with inactive disease at conception (96% in SLE and 89% in UCTD). Hydroxychloroquine at conception was utilized by 86% of women with SLE, in contrast to 36% in the UCTD group. Both, SLE and UCTD cohorts exhibited low rates of disease flares during pregnancy and/or puerperium (14% vs. 10%). The incidence of APOs was 15.6% in SLE patients compared to 5% in those with UCTD (Risk difference 19.5%; 95% confidence interval: −3.9 to 43.1; P=.4237).

Conclusion

Our study underscores the importance of strategic pregnancy planning and the maintenance of appropriate treatment throughout pregnancy to ensure optimal disease management and minimize adverse outcomes in both SLE and UCTD pregnancies.

Keywords:
Adverse pregnancy outcomes
Undifferentiated connective tissue disease
Systemic lupus erythematosus

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