Disease flare-ups and obstetric outcomes in pregnant women with systemic lupus erythematosus

Abstract

Aim:The purpose of this study was to review the maternal and fetal outcomes in pregnant women with systemic lupus erythematosus (SLE), and to evaluate the prognostic risk factors that may contribute to obstetric outcomes or SLE flareups. Methods: We evaluated 100 births in 97 SLE patients who were seen at Osaka University from 1995 to 2013. Main outcome measures included obstetric outcomes and SLE flare-ups. Results: The mean patient age was 30.7 ± 4.6 years, and the nulliparity rate was 62.8%. Corticosteroids were taken by 75.3% of the patients, and 48.5% were on a dosage of ≥ 7.5 mg /day. Disease flare-up and preeclampsia occurred in 17.5% and 11.3% of the patients, respectively. Seven SLE flare-ups (41.2%) occurred after delivery. Fourteen of the patients with a flare-up were taking high dose corticosteroids ( ≥ 7.5 mg /day) and showed significantly poorer obstetric outcomes compared to patients taking low dose corticosteroids ( < 7.5 mg /day) (P = 0.0021). Conclusions: A multidisciplinary approach in the care of pregnant women with SLE is important for good maternal and fetal outcomes. Furthermore, a high daily dosage of corticosteroids may be a prognostic risk factor for adverse SLE flare-ups.

Improved pregnancy outcomes in systemic lupus erythematosus: A retrospective study of pregnancies from a single centre in Denmark from 2010–2020 compared with the period 1990–2010

“…17,36 A study suggest that high dose corticosteroids is a predictor of disease flares in patients taking high dose corticosteroids (≥ 7.5 mg/day). 37 In this study, 48.5% were on corticosteroid doses ≥ 7.5 mg/day, while this was only the case in 10.94% in our study. It is likely that high dose corticosteroids is a proxy for poor disease control rather than a risk factor per se.…”

Pregnancy outcomes in patients with IgA vasculitis with nephropathy (Henoch–Schönlein purpura nephritis) and those with IgA nephropathy: Childhood purpura nephritis is high risk for preeclampsia

“…CKD with hypertension, lupus nephritis, antiphospholipid antibody syndrome, diabetic nephropathy, polycystic kidney disease, and pregnancy after kidney transplantation are associated with a high risk of preeclampsia. 13,14) However, only a few studies have examined pregnancy outcomes according to histological CKD classifications. IgA nephropathy, a renal disease that typically affects children, is also considered a single-organ manifestation of IgA vasculitis, i.e., a disease common in pregnant women.…”

Atypical preeclampsia with systemic lupus erythematosus and elevated soluble fms‐like tyrosine kinase 1/placental growth factor ratio

“…There is a higher risk of an SLE flare during pregnancy if it is activated in the months before pregnancy. 1 Preeclampsia is diagnosed based on new-onset hypertension, proteinuria, and other organ dysfunctions 2 ; therefore, its symptoms are sometimes difficult to distinguish from a flare of SLE. If the patient's ill condition is an exacerbation of a preexisting condition, the treatment involves an intensification of the ongoing treatment; however, if the patient has preeclampsia, the treatment involves fetal delivery.…”