Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy

Abstract

Previous reports suggest that renal involvement before pregnancy or active renal disease during pregnancy may be associated with poor fetal and maternal outcomes in systemic lupus erythematosus (SLE) women. We report our experience of fetal and maternal complications in pregnant lupus women with and without previous lupus nephritis. We analyzed the clinical records of pregnant SLE patients attended in a tertiary reference center during a 5-year period. Patients were allocated into two groups according to the presence or absence of previous lupus nephritis. Women were evaluated monthly during pregnancy and at least 1 month postpartum. Maternal and fetal outcomes of pregnancy were abstracted. We included 95 pregnancies in 92 patients. Compared with pregnant women without lupus nephritis (n = 60), pregnancies with previous lupus nephritis (n = 35) were associated with a higher risk of maternal complications (88.5% vs. 43.3%, p = 0.00001), higher rate of lupus flares (54.2% vs. 25%, p = 0.004), and renal flares (45.7% vs. 6.6%, p = 0.00001), but most of which in most instances were reversible. On the other hand, fetal outcome was similar in both groups. Multivariate analysis showed that previous lupus nephritis and active lupus at conception were predictors of adverse maternal outcome. Pregnancies in women with previous lupus nephritis had a higher rate of maternal complications in comparison with those without. However, fetal prognosis was similar in both groups.

Azathioprine during pregnancy in systemic lupus erythematosus patients is not associated with poor fetal outcome

“…However, azathioprine does not prevent the relapse of the disease in about 50 % of the cases, as we have reported previously [27]. Our results contrast with those reported by other authors [28], perhaps because of the use of relatively low doses of azathioprine that might turn out to be insufficient to maintain disease remission, but it must be emphasized that flares were generally not severe and were kept under control increasing the dose of prednisone.…”

Differential Diagnosis of Preeclampsia

“…This was an unfortunate decision, because flares of lupus are reported to occur in 30% to 60% of pregnant SLE patients. [19][20][21][22] At admission to our department triple immunosuppressive therapy was initiated, and immunosuppressive therapy was later intensified, but proteinuria and BP increased, raising the question of the presence of superimposed preeclampsia. The low sFlt-1/PlGF ratio of 2.8 argued against this diagnosis.…”

A comprehensive review of the clinical approach to pregnancy and systemic lupus erythematosus

“…Present or past history of LN should be regarded as a 'red flag' for pregnancy as the worst maternal outcomes have been observed in these patients. Notably, all deaths of SLE pregnant patients have been reported in those with active LN during pregnancy: disease complications and opportunistic infections were the two leading causes [42,43]. The implications of LN during pregnancy will be discussed in a dedicated paragraph (number 3).…”