Anti-prolactin autoantibodies in pregnant women with systemic lupus erythematosus: maternal and fetal outcome

Abstract

The aim of this study was to determine in pregnant women with systemic lupus erythematosus (SLE) the frequency of anti-prolactin autoantibodies and to compare the outcome of pregnancy in SLE women with and without anti-prolactin autoantibodies. Ninety-nine consecutive SLE pregnant women and 151 healthy pregnant women were studied prospectively. Patients with or without anti-prolactin autoantibodies were identified by gel filtration chromatography and affinity chromatography for IgG. Serum total and free prolactin (PRL) levels and molecular heterogeneity of PRL at each trimester of pregnancy were determined. The frequency of anti-PRL autoantibodies in SLE pregnant women was 13.1%. Serum total PRL levels were significantly higher in women with anti-PRL autoantibodies compared with SLE women without anti-PRL autoantibodies and in healthy pregnant women; and serum free PRL levels were lower in the third trimester in women with anti-PRL autoantibodies than in healthy pregnant women. In contrast, serum total and free PRL levels were significantly lower in the second and third trimester in SLE pregnant women without anti-PRL autoantibodies compared with healthy pregnant women. All adverse outcomes of pregnancy studied were more frequent in SLE women without anti-PRL autoantibodies than anti-PRL autoantibody-positive SLE women. Moreover, both maternal and fetal main complications were significantly higher in SLE women without anti-PRL autoantibodies than anti-PRL autoantibody-positive SLE women (P </=0.03). We conclude that the frequency of anti-PRL autoantibodies in lupus pregnancy was 13.1%. SLE pregnant women with anti-PRL autoantibodies had fewer adverse outcomes of pregnancy. The presence of anti-PRL autoantibodies could be of potential use as a prognostic marker for outcomes of pregnancy in SLE.

Circulating Angiogenic Factors and the Risk of Preeclampsia in Systemic Lupus Erythematosus Pregnancies

“…Consistent with the idea that SLE women are at high risk for developing preeclampsia, we found a high frequency of preeclampsia in our cohort (35.9%), but it was similar to the frequency in previous studies, which ranged from 7.6% to 35% 1,3,6,7,9,10 . In our univariate analysis, we found that the following variables were significantly associated with late-onset preeclampsia: median prednisone dosage at followup, prior hematological manifestations in pregnancy, quiescent renal SLE, and creatinine clearance and 24-h proteinuria at enrollment.…”

“…Although obstetrical management in patients with SLE has improved, and the rate of fetal loss has decreased in recent decades 2 , they still have an increased frequency of adverse pregnancy outcomes including pregnancy loss, intrauterine growth restriction, fetal loss, prematurity, and preeclampsia 1,3,4,5,6,7,8 . Women with SLE usually have normal fertility; therefore pregnancy is common 1 .…”

Prolactin and Autoimmunity

“…Expression of decidual markers such as PRL, activator of Stat 5, and complement regulatory proteins was significantly lower in samples obtained from aPL (+) patients with recurrent pregnancy loss, in comparison with the aPL (−) patient group, before conception [75]. On the other hand, anti-PRL antibodies have been detected in lupus pregnant patients, and they observed a better outcome of pregnancy in comparison with those patients without anti-PRL antibodies [76].…”

Prolactin and Autoimmunity

“…During pregnancy, hyperprolactinemia has been associated with lupus anticoagulant, disease activity, and poor outcomes for mother and fetus (73). In accordance, the presence of anti-PRL antibodies was correlated with lower disease activity and better outcomes in pregnant patients (74,75). The treatment of pregnant women with bromocriptine was shown to prevent disease relapses, improve outcomes, and reduce the doses of concomitant steroidal therapy (76,77).…”