Maternal and fetal complications associated with systemic lupus erythematosus

Abstract

Background: Recent guidelines provide better treatment and management of pregnancy in women with systemic lupus erythematosus (SLE). In this analysis, we aimed to systematically assess the maternal and fetal complications associated with SLE using the most recent studies (2017–2019) to obtain an updated result of the present situation. Methods: http://www.clinicaltrials.gov , MEDLINE, Cochrane Central, Web of Science, EMBASE, and Google Scholar were searched for English based studies comparing maternal and fetal complications in pregnant women with versus without SLE. Maternal and fetal complications were the endpoints in this analysis. The RevMan software 5.3 (latest version) was the most suitable analytical software for this analysis. Data were represented by risk ratio (RR) with 95% confidence interval (CI). Results: A total number of eight million eight hundred and twelve thousand two hundred seventy-two (8,812,272) participants were included in this analysis, consisting of 9696 SLE-associated pregnancy. Based on an analysis of recently published studies (2017–2019), pre-eclampsia/eclampsia was significantly higher in pregnant women with SLE (RR: 3.38, 95% CI: 3.15–3.62; P = .00001). SLE was also associated with an increased risk of stillbirth (RR: 16.49, 95% CI: 2.95–92.13; P = .001) and fetal loss (RR: 7.55, 95% CI: 4.75–11.99; P = .00001). Abortion (RR: 4.70, 95% CI: 3.02–7.29; P = .00001) and the risk for cesarean section due to complications (RR: 1.38, 95% CI: 1.11–1.70; P = .003) were also significantly higher in pregnant women with SLE. In addition, fetal complications including preterm birth (RR: 2.33, 95% CI: 1.78–3.05; P = .00001), infants who were small for gestational age (RR: 2.50, 95% CI: 1.41–4.45; P = .002) and infants with low birth weight (RR: 4.78, 95% CI: 3.65–6.26; P = .00001) were also significantly higher in newborns from mothers with SLE. Moreover, the risk of newborns who were admitted to the neonatal intensive care unit (RR: 2.79, 95% CI: 2.31–3.37; P = .00001), newborns with an APGAR score <7 within 1 minute (RR: 2.47, 95% CI: 1.68–3.62; P = .00001) and 5 minutes (RR: 3.63, 95% CI: 2.04–6.45; P = .0001) respectively, were significantly highly associated with SLE. Conclusions: Based on the most recent studies, we could conclude that maternal and fetal complications were significantly higher in SLE-associated pregnancy. Therefore, SLE should still be considered a severe risk factor for pregnancy.

Maternal Near Miss in Patients with Systemic Lupus Erythematosus

“…Additionally, the PLTC and MNM groups revealed a higher frequency of complications, such as prematurity, stillbirth, miscarriage, neonatal death, low birth weight, and a longer period of hospitalization. We identi ed a high association between SMM and maternal and fetal complications, including low birth weight, neonatal death, fetal loss, and miscarriage, correlating with previous reports [7,[18][19][20][21][22][23]. Prematurity was one of the most signi cant complications, with the majority of pregnancies in the MNM group delivering earlier than 27 weeks (71.5%), with statistically signi cant increased risk of preterm delivery in both MNM and PLTC groups.…”

Pregnancy outcomes in different stages of systemic lupus erythematosus among Chinese women — a retrospective cohort study

“…The caesarean section surgery was accepted by 34 (61.8%) patients in our study. The absolute rate was surprisingly high in both groups, and it was much higher than that reported in most previous studies, but lower than that of another Chinese study [15,20]. SLE was still a risk factor for maternal and fetal outcomes.…”

Anti-CD20 therapies and pregnancy in neuroimmunologic disorders

“…Although the overall risk of PB was similar to other studies, 2 , 24 we found a higher risk for PB (45%) and lower birth weight when anti-CD20 mAb was given during pregnancy. This might be partially related to the underlying disease and/or concomitant autoimmune diseases, 25 especially in NMOSD, to the previous DMT exposure and/or other concomitant medication with steroids, and deserves further investigation. To what extent long-term treatment with anti-CD20 mAbs may lead to hypogammaglobulinemia, which in turn could increase the risk of neonatal and maternal infections 26 , 27 including chorioamnionitis—another potential underlying mechanism of PB—is still unknown.…”