Maternal and fetal outcomes of 72 pregnancies in Argentine patients with systemic lupus erythematosus (SLE)

Abstract

The purpose of the following study was to analyze maternal and fetal outcomes in pregnant patients with systemic lupus erythematosus (SLE) and the influence of SLE exacerbations on those pregnancies. Seventy-two pregnancies in 61 SLE patients treated between January 1986 and February 2004 in Hospital de Clínicas "José de San Martin" were reviewed retrospectively. Patient age was 28.1 +/- 6.2 years (mean+/-standard deviation [SD]). Mean SLE duration was 4.5 +/- 3.2 years (range 6 months-10 years). No patient acquired the disorder during gestation. Four (5.5%) patients had signs of active disease at the beginning of her pregnancy. Sixteen patients, accounting for 20 pregnancies, had a history of lupus nephritis. Nine patients met secondary antiphospholipid syndrome criteria and had 13 pregnancies. There were 14 exacerbations of the disease during pregnancy (19.4%), with most flares being mild. The most common obstetric complications were gestational hypertension in 15 pregnancies (20.8%) and preeclampsia in 8 pregnancies (11%). Forty-six percent of pregnancies ended in preterm deliveries. There were 62 live births (1 twin birth; 85%), 6 stillbirths (8%), and 5 spontaneous abortions (7%). Thirty-nine percent of newborns had low birth weight. Adequate pregnancy follow-up and delivery care by an interdisciplinary team in Argentine SLE patients with no pre-gestational preparation resulted in maternal and fetal outcomes similar to those seen in world reference centers.

Obstetric Nephrology

“…The risk of pre-eclampsia ranges from 11% to 35%, although most reports show that the risk is closer to 30% (14,(17)(18)(19) (20). These data have been corroborated by numerous other studies (19,(21)(22)(23)(24)(25).…”

“…The risk of pre-eclampsia ranges from 11% to 35%, although most reports show that the risk is closer to 30% (14,(17)(18)(19) (20). These data have been corroborated by numerous other studies (19,(21)(22)(23)(24)(25). Anti-Ro/SSA antibodies are associated with an increased risk of congenital heart block (1%-2%), neonatal lupus, and laboratory abnormalities, including hematologic (thrombocytopenia and neutropenia) and hepatic abnormalities (elevated transaminases), in asymptomatic infants within the first 27 days of life (26,27).…”

Pregnancy and Chronic Kidney Disease

“…The prevalence of stillbirth, neonatal, and perinatal deaths reported in papers dealing with at least 25 pregnancies reaches 8% to 15% in different subgroups (8,9,14,22,23,28) and is in the range of 1% to 7% in most series (10,13,19,20,26,27,32); a few maternal deaths are reported (all in lupus patients) related to disease flare-ups (14,23,27). that retrieved 83 and 101 cases with CKD, respectively, the prevalence of live birth was significantly associated with a cutoff of maternal serum creatinine at 1.1 mg/dl.…”

A Systematic Review and Meta-Analysis of Pregnancy Outcomes in Patients with Systemic Lupus Erythematosus and Lupus Nephritis

“…Of these deaths, three of the reported cases described the renal histologic subclass, and all had proliferative disease (7,17,22). Hemodialysis was rarely reported and included two patients who required hemodialysis during their pregnancies (32) and one patient who progressed to endstage renal disease and continued dialysis therapy (35).…”