Fetal and Maternal Outcomes of Planned Pregnancy in Patients with Systemic Lupus Erythematosus: A Retrospective Multicenter Study

Abstract

Objective To investigate the fetal and maternal outcomes as well as predictors of APOs in women with SLE who conceived when the disease was stable, the so-called “planned pregnancy.” Methods. A retrospective multicenter study of 243 patients with SLE who underwent a planned pregnancy was performed. APOs in fetus and mothers were recorded. Results The average age at conception was 28.9 ± 3.9 years. Duration of SLE prior to pregnancy was 4.4 ± 4.3 years. Fetal APOs occurred in 86 (86/243, 35.4%) patients. Preterm births, intrauterine growth retardation (IUGR), fetal distress, and fetal loss accounted for 22.2%, 14.8%, 11.1%, and 4.9%, respectively. Forty-two preterm infants (42/54, 77.8%) were delivered after the 34th week of gestation. All the preterm infants were viable. Fifty-two patients (52/243, 21.4%) had disease flares, among which 45 cases (45/52, 86.5%) were mild, 6 (6/52, 11.5%) were moderate, and 1 (1/52, 1.9%) was severe. Disease flares were mainly presented as active lupus nephritis (41/52, 78.8%), thrombocytopenia (10/52, 19.2%), and skin/mucosa lesions (9/52, 17.3%). Pregnancy-induced hypertension (PIH) occurred in 29 patients, among which 3 were gestational hypertension and 26 were preeclampsia. Multiple analysis showed that disease flares (OR, 8.1; CI, 3.8–17.2) and anticardiolipin antibody positivity (OR, 7.4; CI, 2.5–21.8) were associated with composite fetal APOs. Conclusion Planned pregnancy improved fetal and maternal outcomes, presenting as a lower rate of fetal loss, more favorable outcomes for preterm infants, and less severe disease flares during pregnancy.

WITHDRAWN: No Increase in Rate and Severity of Flares During Pregnancy and Post-Partum Period in Pregnant Patients with Systemic Lupus Erythematosus.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

“…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.…”

Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: A prospective cohort study

“…in contemporary studies. [8][9][11][12]29,[54][55][60][61][62][63] In addition, a recently published Canadian study showed that the use of antimalarial drugs was stopped in up to 30% of patients during pregnancy. That is why we believe that our results reinforce the importance of maintaining antimalarial drugs during pregnancy.…”

“…[2][3][4][5] In retrospective, prospective or population-based studies, preeclampsia has been reported between 10% and 30% of pregnancies in SLE patients. [6][7][8][9][10][11][12][13] The importance of preeclampsia consists of the fact that it is a complication associated with high maternal and fetal morbidity and mortality, mainly in developing countries. 14 In addition, an increased risk of future cardiovascular complications in both newborns and women complicated with preeclampsia has been reported.…”

Preeclampsia Risk Prediction Model for Chinese Pregnant Patients With Systemic Lupus Erythematosus

“…Due to few patients age >40 years and a lack of body mass index (BMI) and family history data, there were no relevant data and no statistical significance in this SLE cohort. Retrospective studies have shown that SLE flare during pregnancy was a high-risk factor for preeclampsia (12,50). SLE flares occurred in 33-57% of pregnant patients, while the frequency of preeclampsia with disease flare varied from 13% to 35% (40).…”

“…There have been many predictive studies regarding preeclampsia, but they were not appropriately generalizable to specific populations, such as women with SLE. Some studies reported adverse pregnancy outcomes in women with SLE (1,(12)(13)(14), and…”