Maternal outcome in pregnant women with lupus nephritis. A prospective multicenter study

Moroni, Gabriella; Doria, Andrea; Giglio, Elisa; Imbasciati, E; Tani, Chiara; Zen, Margherita; Strigini, Francesca Anna Letizia; Zàina, Barbara; Tincani, Anǵela; Gatto, Mariele; Liso, Federica de; Grossi, Claudia; Meroni, Pier Luigi; Cabiddu, Gianfranca; Messa, Piergiorgio; Ravani, Pietro; Mosca, Marta

doi:10.1016/j.jaut.2016.06.012

Cited by 92 publications

(63 citation statements)

References 47 publications

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“…The percentage of patients who developed HELLP syndrome is low in our study with a significantly higher occurrence within the SLE + APS group compared to the other groups. Recently, Moroni et al described maternal outcomes of prospectively followed pregnancies in women with a history of lupus nephritis and found a significant association between anti-beta-2 IgM antibody levels and preeclampsia/HELLP ( p = 0.048) [11]. In our cohort, we only found an association with APS and HELLP.…”

Section: Discussioncontrasting

confidence: 41%

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

Kroese

Abheiden

Blomjous

et al. 2017

Journal of Immunology Research

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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.

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Section: Discussioncontrasting

confidence: 41%

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

Kroese

Abheiden

Blomjous

et al. 2017

Journal of Immunology Research

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“…Interestingly, we found that PIH occurred more frequently in patients with active SLE than in those with new‐onset SLE. Previous studies have reported that lupus nephritis is associated with PIH . In our nine active patients, seven had lupus nephritis.…”

Section: Discussionsupporting

confidence: 49%

Clinical features of new‐onset systemic lupus erythematosus in pregnant patients

Zhang

Mao

Xue

et al. 2017

J of Obstet and Gynaecol

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“…Even low C3 and C4, without systemic manifestations, have been reported to be associated with increased risk in a prospective cohort (21). Other factors that adversely affect pregnancy outcomes, including fetal or neonatal death, birth before 36 weeks due to placental insufficiency, hypertension or preeclampsia, small for gestational age neonate (below the fifth percentile), and maternal renal flares in women with lupus nephritis, include severity of preexisting disease, nonwhite ethnicity, presence of anticardiolipin antibody or lupus anticoagulant, and hypertension (19,21,22). One cohort study suggested that women with classes 3 and 4 lupus nephritis are more likely to have pregnancies complicated by preeclampsia and lower-birth weight babies than those with class 2 or 5 lupus nephritis (23), but histologic class was not associated with different outcomes in the aforementioned meta-analysis (2).…”

Section: Overview Of Pregnancy Outcomes In Lupus Nephritismentioning

confidence: 90%

“…A recent prospective multicenter cohort study of 71 pregnancies in 61 women with lupus nephritis reported an increased odds for preterm delivery by 15% for each increase of proteinuria by 1 g/d every trimester (20). Even low C3 and C4, without systemic manifestations, have been reported to be associated with increased risk in a prospective cohort (21). Other factors that adversely affect pregnancy outcomes, including fetal or neonatal death, birth before 36 weeks due to placental insufficiency, hypertension or preeclampsia, small for gestational age neonate (below the fifth percentile), and maternal renal flares in women with lupus nephritis, include severity of preexisting disease, nonwhite ethnicity, presence of anticardiolipin antibody or lupus anticoagulant, and hypertension (19,21,22).…”

Section: Overview Of Pregnancy Outcomes In Lupus Nephritismentioning

confidence: 99%

“…Hydroxychloroquine is recommended to be commenced or continued for all women with lupus nephritis because prospective cohort studies have shown maternal and fetal benefits (20,21). Those who discontinue hydroxychloroquine have been reported to have higher incidence of lupus flares, leading to greater use of antenatal steroids (27).…”

Section: Overview Of Pregnancy Outcomes In Lupus Nephritismentioning

confidence: 99%

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Pregnancy and Glomerular Disease

Blom

Odutayo

Bramham

et al. 2017

CJASN

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During pregnancy, CKD increases both maternal and fetal risk. Adverse maternal outcomes include progression of underlying renal dysfunction, worsening of urine protein, and hypertension, whereas adverse fetal outcomes include fetal loss, intrauterine growth restriction, and preterm delivery. As such, pregnancy in young women with CKD is anxiety provoking for both the patient and the clinician providing care, and because the heterogeneous group of glomerular diseases often affects young women, this is an area of heightened concern. In this invited review, we discuss pregnancy outcomes in young women with glomerular diseases. We have performed a systematic review in attempt to better understand these outcomes among young women with primary GN, we review the studies of pregnancy outcomes in lupus nephritis, and finally, we provide a potential construct for management. Although it is safe to say that the vast majority of young women with glomerular disease will have a live birth, the counseling that we can provide with respect to individualized risk remains imprecise in primary GN because the existing literature is extremely dated, and all management principles are extrapolated primarily from studies in lupus nephritis and diabetes. As such, the study of pregnancy outcomes and management strategies in these rare diseases requires a renewed interest and a dedicated collaborative effort.

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Maternal outcome in pregnant women with lupus nephritis. A prospective multicenter study

Cited by 92 publications

References 47 publications

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

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

Clinical features of new‐onset systemic lupus erythematosus in pregnant patients

Pregnancy and Glomerular Disease

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