Maternal and fetal outcome of lupus pregnancy: a prospective study of 29 pregnancies

Molad, Yair; Borkowski, T.; Monselise, Assaf; Ben-Haroush, Avi; Sulkes, Jaqueline; Hod, Moshe; Feldberg, Dov; Bar, Jacob

doi:10.1191/0961203305lu2072oa

Cited by 81 publications

(25 citation statements)

References 38 publications

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“…3,13,14) Preeclampsia rate was 11.3% in our study, which falls within the range of 5-38% reported by previous reports. 3,15,16) There was no significant association between the occurrence of preeclampsia and dosage of corticosteroid or previous renal disease.…”

Section: Discussionsupporting

confidence: 74%

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

Takahashi

Mimura

Kanagawa

et al. 2013

Hypertens Res Pregnancy

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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.

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Section: Discussionsupporting

confidence: 74%

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

Takahashi

Mimura

Kanagawa

et al. 2013

Hypertens Res Pregnancy

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“…The risk of maternal morbidity is increased in the setting of active LN (11,23,(44)(45)(46)(47), including an increased risk of hypertensive disorders of pregnancy (42). A recent metaanalysis reported frequencies of 16.3% for hypertension and 7.6% for pre-eclampsia among pregnant LN patients.…”

Section: Maternal Outcomesmentioning

confidence: 99%

Obstetric Nephrology

Stanhope

White

Moder

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary SLE is a multi-organ autoimmune disease that affects women of childbearing age. Renal involvement in the form of either active lupus nephritis (LN) at the time of conception, or a LN new onset or flare during pregnancy increases the risks of preterm delivery, pre-eclampsia, maternal mortality, fetal/neonatal demise, and intrauterine growth restriction. Consequently, current recommendations advise that the affected woman achieve a stable remission of her renal disease for at least 6 months before conception. Hormonal and immune system changes in pregnancy may affect disease activity and progression, and published evidence suggests that there is an increased risk for a LN flare during pregnancy. The major goal of immunosuppressive therapy in pregnancy is control of disease activity with medications that are relatively safe for a growing fetus. Therefore, the use of mycophenolate mofetil, due to increasing evidence supporting its teratogenicity, is contraindicated during pregnancy. Worsening proteinuria, which commonly occurs in proteinuric renal diseases toward the end of pregnancy, should be differentiated from a LN flare and/or preeclampsia, a pregnancy-specific condition clinically characterized by hypertension and proteinuria. These considerations present challenges that underscore the importance of a multidisciplinary team approach when caring for these patients, including a nephrologist, rheumatologist, and obstetrician who have experience with these pregnancyrelated complications. This review discusses the pathogenesis, maternal and fetal risks, and management pertinent to SLE patients with new onset or a history of LN predating pregnancy.

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“…Several prospective studies have suggested that the frequency of these flares may be lowest in the third trimester [28][29][30]. Reported rates of such flares range from 13.5-65% of pregnancies in affected women [31]. The frequency of flares during lupus pregnancies has been the subject of seven prospective comparative studies that have used nonpregnant lupus patients as controls (Table 2).…”

Section: Lupus Flares Associated With Pregnancymentioning

confidence: 99%

Flares of systemic lupus erythematosus during pregnancy and the puerperium: prevention, diagnosis and management

Stojan

Baer²

2012

Expert Review of Clinical Immunology

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Maternal and fetal outcome of lupus pregnancy: a prospective study of 29 pregnancies

Cited by 81 publications

References 38 publications

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

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

Obstetric Nephrology

Flares of systemic lupus erythematosus during pregnancy and the puerperium: prevention, diagnosis and management

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