Outcome of lupus pregnancy: a controlled study

Georgiou, Panagiotis; Politi, Ekaterini; Katsimbri, Pelagia; Sakka, V.; Drosos, Alexandros A.

doi:10.1093/rheumatology/39.9.1014

Cited by 150 publications

(117 citation statements)

References 26 publications

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“…Severe complications, including eclampsia, stroke, and maternal death, were observed in ϳ1% of subjects. Maternal deaths occurred because of opportunistic infections, sepsis, flares of lupus nephritis, and renal impairment (3,7,11,17,22,30,33,35). Of these deaths, three of the reported cases described the renal histologic subclass, and all had proliferative disease (7,17,22).…”

Section: Discussionmentioning

confidence: 99%

“…Maternal deaths occurred because of opportunistic infections, sepsis, flares of lupus nephritis, and renal impairment (3,7,11,17,22,30,33,35). 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).…”

Section: Discussionmentioning

confidence: 99%

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

Smyth¹,

Oliveira²,

Lahr

et al. 2010

Clinical Journal of the American Society of Nephrology

543

437

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Background and objectives: Studies of the impact of systemic lupus erythematosus (SLE) and its pregnancy complications have yielded conflicting results. Major limitations of these studies relate to their small numbers of patients and retrospective designs. The aim of this study was to perform a systematic literature review of pregnancy outcomes in women with SLE and a meta-analysis of the association of lupus nephritis with adverse pregnancy outcomes.Design, setting, participants, & measurements: We searched electronic databases from 1980 to 2009 and reviewed papers with validity criteria. Random-effects analytical methods were used to evaluate pregnancy complications rates.Results: Thirty-seven studies with 1842 patients and 2751 pregnancies were included. Maternal complications included lupus flare (25.6%), hypertension (16.3%), nephritis (16.1%), pre-eclampsia (7.6%), and eclampsia (0.8%). The induced abortion rate was 5.9%, and when excluded, fetal complications included spontaneous abortion (16.0%), stillbirth (3.6%), neonatal deaths (2.5%), and intrauterine growth retardation (12.7%). The unsuccessful pregnancy rate was 23.4%, and the premature birth rate was 39.4%. Meta-regression analysis showed statistically significant positive associations between premature birth rate and active nephritis and increased hypertension rates in subjects with active nephritis or a history of nephritis. History of nephritis was also associated with pre-eclampsia. Anti-phospholipid antibodies were associated with hypertension, premature birth, and an increased rate of induced abortion.Conclusions: In patients with SLE, both lupus nephritis and anti-phospholipid antibodies increase the risks for maternal hypertension and premature births. The presented evidence further supports timing of pregnancy relative to SLE activity and multispecialty care of these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Smyth¹,

Oliveira²,

Lahr

et al. 2010

Clinical Journal of the American Society of Nephrology

543

437

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“…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). Clinical remission of SLE activity and careful control of the disease are associated with improved outcomes, underlying the importance of careful monitoring of these patients throughout pregnancy (28)(29)(30).…”

Section: Sle and Pregnancymentioning

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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“…The risk for skin disease ranges from 25 to 90%, depending on the severity measured. 12,18,19 The rates for arthritis during pregnancy are similarly disparate between studies, based on the severity measured. However, 2 large cohorts demonstrate a 20% risk of significant arthritis, though many more women will have an increase in less-severe joint pain.…”

Section: Types Of Disease Activitymentioning

confidence: 99%

“…12 Hematologic disease, in particular thrombocytopenia, is also common during pregnancy, with the risk ranging from 10-40% in different cohorts. 12,18 The risk for lupus nephritis during lupus ranges from 4% to 30%, based on the cohort characteristics and the definition of lupus nephritis. 9,10,13,20 Women with a prior history of lupus nephritis have 20-30% risk of relapse during pregnancy.…”

Section: Types Of Disease Activitymentioning

confidence: 99%

Lupus Activity in Pregnancy

Clowse

2007

Rheumatic Disease Clinics of North America

238

202

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Pregnancy in a woman with Systemic Lupus Erythematosus (SLE) can be complicated by both lupus activity and pregnancy mishaps. The majority of recent studies demonstrate an increase in lupus activity during pregnancy, perhaps exacerbated by hormonal shifts required to maintain pregnancy. Increased lupus activity, in turn, prompts an elevated risk for poor pregnancy outcomes, including stillbirth, preterm birth, low birth weight, and preeclamspsia. Fortunately, the majority of pregnancies in women with SLE are successful. However, the interaction between pregnancy and SLE activity can lead to complications for both mother and baby.

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Outcome of lupus pregnancy: a controlled study

Abstract: Pregnant women with SLE are at high risk of fetal loss and spontaneous abortion. Pregnancy does not cause life-threatening manifestations of the disease. Thus, for a better outcome of lupus pregnancy, it is essential to control disease activity and to achieve clinical remission.

Cited by 150 publications

References 26 publications

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

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

Obstetric Nephrology

Lupus Activity in Pregnancy

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