Factors associated with adverse pregnancy outcomes in women with systematic lupus erythematosus

Abstract

The aim of this prospective study was to determine clinical factors associated with adverse pregnancy outcomes in women with systematic lupus erythematosus (SLE). Fifty-six pregnancies from 46 women with SLE were enrolled. Risk factors for pregnancy loss, premature delivery, hypertensive disorders of pregnancy (HDP), and light-for-date neonate (LFD), were evaluated. Univariate and multivariate logistic regression analyses revealed a history of two or more pregnancy losses before 10 gestational weeks (GW) (OR 11.5, 95%CI 1.72-76.8) as a risk factor for pregnancy loss; low levels of blood complements (OR 7.55, 95%CI 1.10-51.9) and antiphospholipid syndrome (OR 26.5, 95%CI 3.17-219) as risk factors for premature delivery before 37 GW; SLEDAI score at conception (OR 1.68, 95%CI 1.05-2.68) and positive tests for two or more antiphospholipid antibodies (OR 6.89, 95%CI 1.13-41.9) as risk factors for premature delivery before 34 GW; prednisolone therapy >14mg/day (OR 7.55, 95%CI 1.10-51.9) as a risk factor for HDP; and low dose aspirin therapy (OR 0.21, 95%CI 0.05-0.97) decreased the risk for LFD neonate. These results have important implications for clinicians managing SLE complicated pregnancy.

Damage accrual related to pregnancies before and after diagnosis of systemic lupus erythematosus: a cross-sectional and nested case-control analysis from a lupus registry

“…In the present study, the following parameters were listed as candidate confounders based on previous reports: hypertension, aPL, SLEDAI, GC dose and concomitant immunosuppressant usage. [5][6][7][8][9][10][11]14,15 Final confounders for the conditional logistic regression analysis were selected based on the results of the univariate analysis. Missing data were not complemented in the present study.…”

“…In this study, only half of the pregnancies after the diagnosis ended in live births, while previous reports have shown that 77-99% of the pregnancies after diagnosis ended in live births. 14,15,22,25 Some reports have shown disease activity, APS and GC usage as predictors for APOs. 14,15 In the present study, patients becoming pregnant after diagnosis showed a higher prevalence of aPL with higher GC dose and tended to have higher disease activity.…”

“…12,13 Some reports have shown disease activity, APS and GC usage as predictors for APOs. 14,15 A previous study showed that the pregnancy itself did not relate to chronic damage at the first visit after the deliveries, but chronic damage in patients with longer observation was not elucidated. 16 A recent report showed that pregnancy after the diagnosis of lupus nephritis did not affect damage accrual during about eight years of observation.…”

Stratifying management of rheumatic disease for pregnancy and breastfeeding

“…Glucocorticoids are associated with an increased risk of premature birth and some reports have suggested that this increased risk is independent of disease activity 10,82 . Some studies in SLE have detected an association between these drugs and premature rupture of the amniotic sac (known as rupture of membranes) surrounding the baby 83 , but other studies did not detect this association [84][85][86] . Fluorinated corticosteroids are not metabolised by the placenta and cross the placental barrier 87 , so these drugs should be used for fetal indications only.…”

Effects of perinatal disease activity on offspring’s growth in patients with systemic lupus erythematosus

“…A variety of factors may be related to fetal and maternal adverse outcomes, among which disease activity is the most concerned 5 . Lupus nephritis has been shown to increase the risk of hypertension disorders of pregnancy in SLE women 6 , and even those with previous renal flare were reported to have increased incidence of eclampsia 7 and FGR 8 . Consequently, SLE women is recommended to consider pregnancy during periods of inactive or stable disease 9 , because active disease has been displayed as an important predictor for poor pregnancy outcomes 10 , while a remission at least six months before conception could reduce the risk of unfavorable pregnancy outcomes 11 .…”