Maternal disease activity and serological activity as predictors of adverse pregnancy outcomes in women with systemic lupus erythematosus: a retrospective chart review

Murata, Tsuyoshi; Kyozuka, Hyo; Fukuda, Toma; Toba, Naoya; Kanno, Aya; Yasuda, Shun; Nomura, Yasuhisa; Kanno, Takashi; Migita, Kiyoshi; Fujimori, Keiya

doi:10.1007/s00404-021-06148-x

Cited by 9 publications

(4 citation statements)

References 34 publications

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“…Glucocorticoids, antimalarials and azathioprine were used by 20%, 24% and 8% of the pregnant SLE patients, respectively [ 46 ]. At the same time, there is a growing body of literature showing that active disease is one of the major risk factors antedating complications during pregnancy in SLE patients [ 35 , 47 ]. The present result draws our attention to the importance of considering proper counselling of patients during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Pregnancies in patients with systemic lupus erythematosus during 2000–2018 in Finland: a case–control study

Elfving,

Kariniemi,

Kautiainen

et al. 2024

Rheumatol Int

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Objectives The aim was to investigate, how pregnancies proceed in patients with systemic lupus erythematosus (SLE) compared to their individually matched population controls. Material and methods Adult incident SLE patients were identified from the register of new special reimbursement decisions for SLE drugs in 2000–2014. For each patient, 1–3 randomly selected controls from the Population Register Centre were matched. Data regarding pregnancies were obtained from the Finnish Medical Birth Register, Care Register and Register of Congenital Malformations until 2018. The study utilized data from the Drug Purchase Register and educational information from Statistic Finland. Results A total of 163 deliveries for 103 mothers with SLE and 580 deliveries for 371 population controls were identified. The duration of pregnancies in SLE women was significantly shorter compared to controls (38.9 versus 39.6 weeks). There were more urgent Caesarean Sections. (15% versus 9%) and need for care at neonatal intensive care unit (NICU) (21% versus 11%) among deliveries in SLE mothers. No statistical difference was observed between SLE and control groups in the occurrence of preeclampsia or major congenital malformations. Gestational age was 2.5 weeks shorter when the mother experienced pre-eclampsia. Hydroxychloroquine was purchased by 30% of SLE mothers during pregnancy. Conclusion The course of pregnancies in Finnish SLE patients seems to be quite moderate compared to controls, and no new safety issues were detected. The low utilization of hydroxychloroquine indicates that the benefits of the drug to pregnancy and disease course are not optimally recognized by specialists treating SLE mothers.

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Section: Discussionmentioning

confidence: 99%

Pregnancies in patients with systemic lupus erythematosus during 2000–2018 in Finland: a case–control study

Elfving,

Kariniemi,

Kautiainen

et al. 2024

Rheumatol Int

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“…Women with a clinical diagnosis of lupus flare during pregnancy were excluded due to the association between lupus flare and adverse pregnancy outcomes independent of proteinuria. 14 Demographic and clinical data included age, body mass index, kidney disease diagnosis, pre-pregnancy serum creatinine concentration, prepregnancy estimated glomerular filtration rate (eGFR) by CKD-EPI, 6 prepregnancy diabetes, the use of renin-angiotensin blockade prior to pregnancy, immunosuppressive medication in pregnancy, venous thromboembolism prophylaxis with low molecular weight heparin and kidney biopsy. A diagnosis of chronic hypertension was made if there was a sustained systolic blood pressure of 140 mm Hg or higher or sustained diastolic blood pressure of 90 mm Hg or higher prior to 20 weeks' gestation, or if treatment for hypertension was initiated prior to 20 weeks' gestation.…”

Section: Methodsmentioning

confidence: 99%

“…Women with a clinical diagnosis of lupus flare during pregnancy were excluded due to the association between lupus flare and adverse pregnancy outcomes independent of proteinuria. 14…”

Section: Methodsmentioning

confidence: 99%

Pregnancy in women with nephrotic-range proteinuria: A retrospective cohort study

Svetitsky,

Lightstone,

Wiles

2023

Obstet Med

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Background Obstetric and kidney outcomes following detection of nephrotic-range proteinuria in early pregnancy have not been well described. Methods A retrospective cohort study of chronic kidney disease (CKD) in pregnancy between 2008 and 2018. Outcomes in those with nephrotic-range proteinuria before 20 weeks’ gestation were compared to those without nephrotic-range proteinuria. Results The study included 37 women with nephrotic-range proteinuria and 62 women without. Pre-pregnancy estimated glomerular filtration rate (eGFR) was similar. Nephrotic-range proteinuria was associated with higher rates of preterm (odds ratio [OR] 1.77, 95% confidence interval [CI]: 1.07–2.92) and early preterm delivery (OR 2.63, 95% CI: 1.12–6.2), and with a requirement for renal replacement therapy at 3 years post-partum (OR 10.72, 95% CI: 2.58–44.47). Tubulointerstitial scarring on kidney biopsy was associated with early preterm delivery and progression to advanced CKD, independent of pre-pregnancy eGFR. Conclusion Compared to CKD without nephrotic-range proteinuria, nephrotic-range proteinuria early in pregnancy is associated with higher rates of pre-term delivery and progression to advanced CKD.

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“…It can affect fertility and cause certain complications during pregnancy such as preterm labor and delivery, high blood pressure (pre-eclampsia), placental insufficiency, miscarriage or stillbirth. Furthermore, it can cause mortality, preterm birth, and neonatal lupus (a temporary condition in the baby caused by SLE-related antibodies) and structural abnormalities in the fetus [60].…”

Section: The Drawbacks Of Glucocorticosteroids In Treating Inflammato...mentioning

confidence: 99%

The dichotomy of glucocorticosteroid treatment in immuneinflammatory rheumatic diseases: an evidence-based perspective and insights from clinical practice

Hysa,

Vojinovic,

Gotelli

et al. 2023

Reumatologia

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ObjectivesGlucocorticosteroids (GCs) are the most used anti-inflammatory and immunosuppressive drugs due to their effectiveness in managing pain and disease modification in many immune-inflammatory rheumatic diseases (IRDs). However, their use is limited because of adverse effects (AEs).Material and methodsThe authors analyzed recent studies, including randomized controlled trials (RCTs), observational, translational studies and systematic reviews, providing an in-depth viewpoint on the benefits and drawbacks of GC use in rheumatology.ResultsGlucocorticosteroids are essential in managing life-threatening autoimmune diseases and a cornerstone in many IRDs given their swift onset of action, necessary in flares. Several RCTs and meta-analyses have demonstrated that when administered over a long time and on a low-dose basis, GC can slow the radiographic progression in early rheumatoid arthritis (RA) patients by at least 50%, satisfying the conventional definition of a disease-modifying anti-rheumatic drug (DMARD). In the context of RA treatment, the use of modified-release prednisone formulations at night may offer the option of respecting circadian rhythms of both inflammatory response and HPA activation, thereby enabling low-dose GC administration to mitigate nocturnal inflammation and prolonged morning fatigue and joint stiffness. Long-term GC use should be individualized based on patient characteristics and minimized due to their potential AEs. Their chronic use, especially at medium/high dosages, might cause irreversible organ damage due to the burden of metabolic systemic effects and increased risk of infections. Many international guidelines recommend tapering/withdrawal of GCs in sustained remission. Treat-to-target (T2T) strategies are critical in setting targets for disease activity and reducing/discontinuing GCs once control is achieved.ConclusionsGlucocorticosteroids’ use in treating IRDs should be judicious, focused on minimizing use, tapering and discontinuing treatment, when possible, to improve long-term safety. Glucocorticosteroids remain part of many therapeutic regimens, particularly at low doses, and elderly RA patients, especially with associated chronic comorbidities, may benefit from long-term low-dose GC treatment. A personalized GC therapy is essential for optimal long-term outcomes.

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Maternal disease activity and serological activity as predictors of adverse pregnancy outcomes in women with systemic lupus erythematosus: a retrospective chart review

Cited by 9 publications

References 34 publications

Pregnancies in patients with systemic lupus erythematosus during 2000–2018 in Finland: a case–control study

Pregnancies in patients with systemic lupus erythematosus during 2000–2018 in Finland: a case–control study

Pregnancy in women with nephrotic-range proteinuria: A retrospective cohort study

The dichotomy of glucocorticosteroid treatment in immuneinflammatory rheumatic diseases: an evidence-based perspective and insights from clinical practice

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