Systemic lupus erythematosus and pregnancy: clinical evolution, maternal and perinatal outcomes and placental findings

Abstract

CONTEXT AND OBJECTIVE: Systemic lupus erythematosus is a chronic disease that is more frequent in women of reproductive age. The relationship between lupus and pregnancy is problematic: maternal and fetal outcomes are worse than in the general population, and the management of flare-ups is difficult during this period. The aim here was to compare the outcomes of 76 pregnancies in 67 women with lupus, according to the occurrence or absence of flare-ups. DESIGN AND SETTING: An observational cohort clinical study evaluating the evolution of pregnant women with lupus who were receiving care at the prenatal outpatient clinic, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp), between 1995 and 2002. METHODS: Data were collected on a precoded form. The women were divided into two groups according to the occurrence or absence of flare-ups, as defined by the systemic lupus erythematosus disease activity index (SLEDAI). The presence or absence of flare-ups and renal involvement was considered to be the independent variable and the other results were dependent variables. RESULTS: Flare-ups occurred in 85.3% of cases, and were most significant when there was renal involvement. This was related to greater numbers of women with preeclampsia and poor perinatal outcome. Intrauterine growth restriction was more common in the women with active disease. Placental weight was significantly lower in the women with renal involvement. CONCLUSIONS: Flare-ups and renal involvement in lupus patients during pregnancy are associated with increased maternal and perinatal complications.

Obstetric Nephrology

“…The risk of pre-eclampsia ranges from 11% to 35%, although most reports show that the risk is closer to 30% (14,(17)(18)(19) (20). These data have been corroborated by numerous other studies (19,(21)(22)(23)(24)(25). Anti-Ro/SSA antibodies are associated with an increased risk of congenital heart block (1%-2%), neonatal lupus, and laboratory abnormalities, including hematologic (thrombocytopenia and neutropenia) and hepatic abnormalities (elevated transaminases), in asymptomatic infants within the first 27 days of life (26,27).…”

Managing pregnancy in inflammatory rheumatological diseases

“…Flares are typically cutaneous, arthritic, or hematological. The risk of flare is increased if there is evidence of a flare within 6 months prior to conception, active lupus nephritis, very active lupus in the past, and/or discontinuation of medication [9-11]. There is a risk of flares in the postpartum period even if disease has been in remission before and during pregnancy.…”

“…The risk of IUGR is increased in those with active disease at conception and in those with anti-phospholipid antibodies [9,11,16]. IUGR increases the risk of premature delivery and is thought to occur due to uteroplacental dysfunction secondary to thrombosis and complement activation; however, the exact mechanisms are unknown [17].…”

Trophoblast Giant Cells, the Prime Suspects of Deficient Placentation Associated With Pregnancy Complications

“…These conditions also have been found in placental tissues of diabetic mothers and patients with PE during pregnancy (11). Stereological insight into placental changes during several diseases affecting pregnancy, such as lupus and placenta previa, in our previous studies, have showed that the disturbance of the normal structure of placenta might lead to perilous pregnancy for mother and afterward fetus (1,2).…”

“…According to previous studies, during pregnancycomplicating conditions, altered expression of several cellular factors in trophoblast and abnormality in the development and secretory function of TGCs are probably related to impaired placentation and maternal and/or fetal unpleasant fate (11). For example, investigations in pregnant patients with lupus erythematosus disease demonstrated that abnormal vascular remodeling is associated with defective placental attachment.…”