The purpose of the following study was to analyze maternal and fetal outcomes in pregnant patients with systemic lupus erythematosus (SLE) and the influence of SLE exacerbations on those pregnancies. Seventy-two pregnancies in 61 SLE patients treated between January 1986 and February 2004 in Hospital de Clínicas "José de San Martin" were reviewed retrospectively. Patient age was 28.1 +/- 6.2 years (mean+/-standard deviation [SD]). Mean SLE duration was 4.5 +/- 3.2 years (range 6 months-10 years). No patient acquired the disorder during gestation. Four (5.5%) patients had signs of active disease at the beginning of her pregnancy. Sixteen patients, accounting for 20 pregnancies, had a history of lupus nephritis. Nine patients met secondary antiphospholipid syndrome criteria and had 13 pregnancies. There were 14 exacerbations of the disease during pregnancy (19.4%), with most flares being mild. The most common obstetric complications were gestational hypertension in 15 pregnancies (20.8%) and preeclampsia in 8 pregnancies (11%). Forty-six percent of pregnancies ended in preterm deliveries. There were 62 live births (1 twin birth; 85%), 6 stillbirths (8%), and 5 spontaneous abortions (7%). Thirty-nine percent of newborns had low birth weight. Adequate pregnancy follow-up and delivery care by an interdisciplinary team in Argentine SLE patients with no pre-gestational preparation resulted in maternal and fetal outcomes similar to those seen in world reference centers.
Background: Inflammatory, metabolic and immunological disorders affecting the fetus in different ways commonly occur during pregnancy. Disorders such as abortion, intrauterine growth restriction (IUGR), low birth weight and neonatal mortality are known to occur in early life and cardiovascular and metabolic disease could occur in adult life. Objective: To analyze different biochemical parameters (BP) for the early detection of perinatal complications in maternal venous blood (MVB) and newborns' umbilical cord blood (UCB) from healthy mothers and mothers with underlying conditions or diseases associated with gestation. Materials-Methods: Samples from MVB (173) and UCB (173) were analyzed. Delivery was via cesarean section. Mothers and newborns were classified into two groups: the control group (C-n = 64) and the pathological group (P-n = 109). Maternal diseases: diabetes, hypertension, anti-phospholipid syndrome, hyper/hypotiroidism, intrahepatic-cholestasis and genital infections. Newborn disorders: IUGR and/or fetal distress. BP:Glucose,urea,creatinine, uric acid, total bilirubin, proteins, albumin, transaminases (ALT/AST), alkaline phosphatase, gamma-glutamyltranspeptidase (GGT), creatine kinase, lactatedehydrogenase (LDH), iron, calcium, phosphorus, magnesium, sodium, potassium(K), chlorine, cholesterol, triglycerides, hsCRP were measured by recommended methods-Roche autoanalizer. Student's and Mann Whitney tests were performed, p < 0.05. Results: -P newborns from P mothers showed significant decrease in gestation weeks (GW) and newborn weight (NW) with respect to C newborns from C mothers (p: 0.001; 0.01, respectively); significant increases in K, AST, LDH, GGT (p:0,005;0,03;0,03;0,02;respectively). -P mothers showed significant increase in hsCRP (p: 0.02) with respect to C mothers. Conclusions: In P newborns from P mothers with respect to C, the decrease in GW and NW might be related to IUGR, a typical condition associated with these disorders; increases in K, AST, LDH, GGT would be related to cellular destruction associated to maternal disorders and deficit in pulmonary development as a result of IUGR, respectively. The increase in hsCRP from P mothers with respect to C mothers could be associated to an inflammatory process. A future study with a greater number of samples and analysis of each maternal disease is proposed in order to obtain early markers of neonatal damage.
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