Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies

Naseri, Estephania Pignaton; Surita, Fernanda Garanhani; Borovac-Pinheiro, Anderson; Santos, Marília Paula Souza; Appenzeller, Simone; Costallat, Lílian Tereza Lavras

doi:10.1055/s-0038-1672136

Cited by 18 publications

(32 citation statements)

References 21 publications

(43 reference statements)

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“…This might be due to the study including all of the ares that occurred after pregnancy termination or delivery, when increasing dosage of corticosteroids or an addition of immunosuppressive therapy was given to control SLE; thus, the ares were counted in order to comply with are de nition according to the SFI [20]. The incidence of ares during each trimester and the post-partum period in this study, and some selected previous reports [4][5][6][7][8][9][22][23][24][25], are shown in Table 6. There was a wide range in the incidence of ares among previous study reports.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: No Increase in Rate and Severity of Flares During Pregnancy and Post-Partum Period in Pregnant Patients with Systemic Lupus Erythematosus. A Sex, Age and Disease Duration Matched Controlled Study

Louthrenoo

Trongkamolthum

Kasitatnon

et al. 2020

Preprint

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Background: Flares in pregnant patients with systemic lupus erythematosus (SLE) have shown conflicting results. This study aimed to determine the disease activity, and rate and severity of flares in pregnant SLE patients compared with the non-pregnant SLE controls. Methods: The medical records of pregnant patients in the SLE cohort were identified. Controls were non-pregnant female SLE patients who were matched for age at diagnosis and disease duration prior to conception. Disease activity was determined by mSLEDAI-2K. The definition and severity of flares followed the SELANA-SLEDAI Flare Index. The disease activity was measured from 6 months prior to conception (-6M) until termination of pregnancy or delivery.Results: Ninety pregnancies occurred from 77 patients, of whom 36.67% had active disease at the time of conception. The pregnancy group was slightly, but significantly, younger than the control group at diagnosis (21.63 ± 5.89 years vs. 24.05 ± 7.27 years, p = 0.015). The SLE disease activity (mSLEDAI-2K) score was comparable in both groups from -6M to the post-partum period, with that in the control group being slightly but significantly higher than that in the pregnancy group at conception (3.57 ± 4.28 vs. 1.91 ± 3.44, p = 0.003). Of the 90 pregnancies, the overall incidence of flares in both groups was similar during pregnancy (39 vs. 26, p = 0.070). There also was no difference in the incidence of flare during each trimester, with 19 vs.7 flares among 90 pregnancies (p = 0.588) in the 1st, 12 vs. 12 among 82 (p = 0.682) in the 2nd, and 6 vs. 7 among 71 (p = 0.266) in the 3rd trimester. The incidence of flare during the post-partum period also was similar (42 vs. 30 flares among 90 pregnancies, p = 0.091). There was no difference in the severity of flare in each trimester, overall flare during pregnancy or post-partum flare. Conclusions: This study found no difference in flare rate or severity of flares between pregnant SLE patients and non-pregnant SLE controls, who were matched by sex, age at diagnosis and disease duration prior to pregnancy.

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Section: Discussionmentioning

confidence: 99%

WITHDRAWN: No Increase in Rate and Severity of Flares During Pregnancy and Post-Partum Period in Pregnant Patients with Systemic Lupus Erythematosus. A Sex, Age and Disease Duration Matched Controlled Study

Louthrenoo

Trongkamolthum

Kasitatnon

et al. 2020

Preprint

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“…A previous study 8 conducted between 1995 and 2005 has shown a rate of 85.3%. More recently, another study 18 conducted between 2002 and 2012 demonstrated a rate of 39.2%, ultimately reaching a rate a little more than 25% of our current sample. This improvement was largely based on specialized care, with the adoption of institutional protocols specifically aimed at the obstetric follow-up of women with SLE.…”

Section: Discussionmentioning

confidence: 42%

“…Our frequency of gestational loss was of 9.8%: two cases of neonatal deaths, four fetal deaths and four miscarriages. In fact, a certain improvement could be noticed in our rates, although they are still considered high: Previous studies conducted at our center showed rates of gestational loss of 23.2% (between 2002 and 2012) 18 and 18.2% (between 1995 and 2002). 8 It is important to note that our miscarriage rate is relatively low, possibly due to a later prenatal follow-up schedule begun at our institution, which makes it difficult to account for the early abortions in our sample.…”

Section: Discussionmentioning

confidence: 48%

Systemic lupus erythematosus and pregnancy: the challenge of improving antenatal care and outcomes

Pastore

Costa

Surita

2019

Lupus

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Objectives The objective of this article is to describe maternal and perinatal outcomes in women with systemic lupus erythematosus (SLE) followed in a high-risk prenatal outpatient clinic at a referral center. Methods This observational study included pregnant women with SLE who underwent prenatal follow-up and childbirth at the Women’s Hospital, University of Campinas, from January 2012 to January 2018. All women were followed according to the institution’s protocol for pregnant women with SLE. They were subdivided into two groups according to the presence of disease activity during the preconception and gestation periods, and evaluated according to the Systemic Lupus Erythematosus Disease Activity Index and Systemic Lupus Erythematosus Pregnancy Disease Activity Index scales. Data were retrieved from patients’ medical records. Chi-square, Fisher exact and Mann-Whitney tests and multivariable analyses were performed. Statistical significance level was 5% ( p < .05). Results A total of 125 cases were initially included; those who were lost to follow-up or gave birth at another hospital were further excluded, with 102 pregnancies (of 95 women) remaining. The mean age of the women was 27.7 years (SD 5.44), and 48% were in their first gestation. The average duration of disease was 6.79 years (SD 5.38), with 92.1% receiving SLE-specific therapy. SLE flare occurred in 8.9% during the preconception period and 23.5% during gestation. Preterm premature rupture of membranes (16.6%), preeclampsia or eclampsia (15.6%) and preterm labor (12.7%) were the most frequent complications. The mean gestational age at birth was 34.4 weeks (SD 5.9); the preterm birth rate was 46.8%, the low birth weight rate was 35.1%, and intensive neonatal care admission was 40.4%. Four fetal deaths and one maternal death occurred, all of them in the group with SLE flares. Multivariable logistic regression analysis showed that preconception lupus activity had a six-fold increased rate of gestational loss (odds ratio (OR): 6.14 (95% confidence interval (CI) 1.26–29.99)), and lupus activity during pregnancy had a five-fold increased rate of prematurity at less than 34 weeks (OR: 5.02 (95% CI: 1.90–13.30)). Conclusions Despite the low percentages of women with pregestational and pregnancy-active disease, we found high incidences of maternal and perinatal complications. Preconception SLE activity increased gestational loss, and SLE activity during pregnancy increased prematurity. Effective immunosuppressive therapy was able to decrease clinical and laboratory activity of SLE; however, unfavorable perinatal outcomes still occurred, even when lupus activity was under control. Pregnancy in women with SLE is always a challenge.

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“…En nuestra población, la mayoría de las pacientes estaban en la tercera década de la vida, igual a lo reportado por otras series latinoamericanas (10)(11)(12)(13)(14)25) . Sin embargo, el porcentaje de hipertensión crónica fue mayor a lo descrito en otros estudios (5,9) , probablemente, dado el mayor número de pacientes con compromiso renal previo.…”

Section: Tratamientounclassified

“…En Latinoamérica la información disponible es escasa y proviene principalmente de series de casos de Chile, Argentina, Brasil y México (10)(11)(12)(13)(14) , en las que se observa un comportamiento heterogéneo en cuanto a los desenlaces maternos, obstétricos y la actividad del lupus. Debido a esta variabilidad en los resultados y la falta de información local, se propuso evaluar las características epidemiológicas, clínicas y de tratamiento de las gestantes con LES y sus desenlaces obstétricos en dos centros de referencia en el noroeste de Colombia.…”

Section: Introductionunclassified

Caracterización de mujeres embarazadas con lupus eritematoso sistémico y resultados materno-fetales en el noroeste de Colombia. Estudio descriptivo

Ocampo-Ramírez

Hoyos-Patiño

Lambertino-Montaño

et al. 2019

Iatreia

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Objetivo: evaluar las características epidemiológicas, clínicas y de tratamiento de las mujeres embarazadas con lupus eritematoso sistémico, así como sus resultados obstétricos, en dos centros de referencia en el noroeste de Colombia.Métodos: serie de casos retrospectiva que evaluó las gestantes atendidas en la Unidad de Medicina Materno Fetal y en el servicio de Reumatología entre 2010 y 2015.Resultados: se incluyeron 40 pacientes y 43 embarazos. Edad promedio al diagnóstico: 24 ± 7 años; 22 (55 %) fueron primigestantes. La afectación clínica más frecuente fue articular (n = 32; 80 %). Ocho de 43 embarazos (18,6 %) presentaron actividad lúpica al inicio de éste. La complicación obstétrica más frecuente fue preeclampsia en 11/43 (25,6 %) embarazos. La complicación fetal más común fue el parto prematuro (8/43; 18,6 %). Los anticuerpos anticardiolipinas y anti-DNA fueron positivos en 10/43 (23,3 %) y en 15/38 (39,5 %) embarazos, respectivamente. En 13 gestaciones (31,7 %) hubo recaídas durante el tercer trimestre, y de éstas, en seis casos (46,1 %) fue grave, especialmente nefritis. Al ingreso, en 29/43 (65 %) embarazos se utilizó prednisona y en 32/43 (74,4 %) antimaláricos. En el puerperio dos pacientes presentaron recaída moderada y dos madres tuvieron preeclampsia. No se encontraron muertes maternas y la supervivencia perinatal fue 86 % (37/43 gestaciones).Discusión: en esta cohorte de pacientes con LES y embarazo, la nefritis y los anticuerpos antifosfolípidos estaban presentes en gran parte de las pacientes con complicaciones obstétricas, aunque un bajo porcentaje de pacientes estuvo activa antes de la gestación; las complicaciones maternas y fetales fueron frecuentes.

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Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies

Cited by 18 publications

References 21 publications

WITHDRAWN: No Increase in Rate and Severity of Flares During Pregnancy and Post-Partum Period in Pregnant Patients with Systemic Lupus Erythematosus. A Sex, Age and Disease Duration Matched Controlled Study

WITHDRAWN: No Increase in Rate and Severity of Flares During Pregnancy and Post-Partum Period in Pregnant Patients with Systemic Lupus Erythematosus. A Sex, Age and Disease Duration Matched Controlled Study

Systemic lupus erythematosus and pregnancy: the challenge of improving antenatal care and outcomes

Caracterización de mujeres embarazadas con lupus eritematoso sistémico y resultados materno-fetales en el noroeste de Colombia. Estudio descriptivo

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