Maternal and Perinatal Outcome in Women with Systemic Lupus Erythematosus: A Retrospective Bicenter Cohort Study

Abstract

Objective To investigate disease activity around and during pregnancy and pregnancy outcome in women with systemic lupus erythematosus (SLE) considering antiphospholipid antibody status. Moreover, differences between first and consecutive pregnancies were examined. Methods Pregnancies > 16 weeks gestation of SLE patients receiving joint care from rheumatologists and gynecologists in two tertiary centers in the Netherlands between 2000 and 2015 were included. Disease activity, flare rate, and pregnancy outcomes and complications were assessed. Results Ninety-six women (84% Caucasian) with 144 pregnancies were included. The median SLE(P)DAI score was 2 before, during, and after pregnancy. Flare rates were 6.3%, 20.1%, and 15.3%, respectively. Severe hypertensive disorder of pregnancy, intrauterine fetal death, preterm birth, and small-for-gestational age infants occurred in 18.1%, 4.1%, 32.7%, and 14.8%, respectively. Complication rates were similar in the first and consecutive pregnancies. Half of the women did not experience any pregnancy complication whereas 42.7% developed a complication during all pregnancies. Mean number of pregnancies was 2.4 and live births 1.7. Conclusion In this SLE population with low disease activity, pregnancy complications were present irrespective of antiphospholipid antibody status. Furthermore, there were no differences in complication rates between the first and consecutive pregnancies as seen in healthy mothers. This information is useful for patient counseling.

Predicting factors of adverse pregnancy outcomes in Thai patients with systemic lupus erythematosus

“…The PIH and eclampsia prevalence of 8.89% and 1.11%, respectively, in this study was in line with many previous reports that showed prevalence of 0–19% and 0–20% for PIH [ 20 , 23 – 27 ] and pre-eclampsia, respectively [ 20 , 23 – 27 ] . However, when looking at details, studies with a high incidence of PIH had a rather low incidence of pre-eclampsia or vise-versa; except for that reported by Wu et al, [ 27 ] and Kroese et al [ 23 ] The reason for the discordance among these reports was unclear. It is not easy in clinical practice to differentiate between PIH and pre-eclampsia in pregnant patients with pre-existing hypertension and renal disease, as hypertension is an important clinical feature in both conditions.…”

“…This study also found that pregnancy outcomes of subsequent pregnancies in SLE patients showed a slightly decreased proportion of live births, full-term births, and SGA and LBW infants, but with slightly increased proportion of fetal loss, particularly among medical terminations. The lower proportion of SGA and LBW in the subsequent pregnancies in this study was similar to that of Wallanius et al, [ 22 ] but different from that of Korese et al, [ 23 ] who found that the fetal and maternal outcomes were almost similar between the first and subsequent pregnancies, except for the latter having slightly lower pre-term births. Reasons for the higher proportion of medical terminations in subsequent pregnancies in this study were not clear, but this might have been due to decisions made by the mothers and physicians, who were afraid of severe maternal or fetal complications if the pregnancy continued, and the patients probably had a baby already from the previous pregnancy.…”

Maternal and fetal outcomes of lupus pregnancies: A collective effort by Karnataka Rheumatologists

“…A similar observation was made in another Indian study by Chandran et al. 18 However, the live birth rates, even in those with inactive disease (68.8%), are lower in our cohort than in the PROMISSE cohort (95%). 2 This again could be explained by the lupus-related increased prevalence of HDP.…”

Changes in the blood level, efficacy, and safety of tacrolimus in pregnancy and the lactation period in patients with systemic lupus erythematosus

“…The general incidences of miscarriage and stillbirth and of preterm birth in SLE have been reported to be 13–34 and 6–46%, respectively. 23–26 In the present study, no malformation was noted in any infant. The incidence of miscarriage and stillbirth was 16%, lower than that in previous studies, and the incidence of preterm birth was 33.3%, indicating no difference from other previous studies.…”