Pregnancy in women with pre-existing lupus nephritis: predictors of fetal and maternal outcome

Imbasciati, E; Tincani, Anǵela; Gregorini, Gina; Doria, Andrea; Moroni, Gabriella; Cabiddu, Gianfranca; Marcelli, Daniele

doi:10.1093/ndt/gfn348

Cited by 196 publications

(152 citation statements)

References 29 publications

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“…SLE patients were more often diagnosed with renal disease before pregnancy. Renal disease is a concern because it has been associated with pregnancy complications, such as hypertension, early-onset preeclampsia, renal flare, fetal loss, preterm births, and low BW (5,(25)(26)(27)(28)(29). However, the rates of renal disease diagnosed before pregnancy in the present study (5% in the first pregnancy and 2.7% in subsequent pregnancies) were lower than those in a previous report (11%) (7).…”

Section: Discussioncontrasting

confidence: 84%

Systemic Lupus Erythematosus and Outcomes in First and Subsequent Births Based on Data From a National Birth Registry

Wallenius

Salvesen

Daltveit

et al. 2014

Arthritis Care & Research

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Section: Discussioncontrasting

confidence: 84%

Systemic Lupus Erythematosus and Outcomes in First and Subsequent Births Based on Data From a National Birth Registry

Wallenius

Salvesen

Daltveit

et al. 2014

Arthritis Care & Research

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“…This observation should not lead us to underestimate the risk in patients with CKD, but may scale it down, at least within the "standard" kidney diseases. [16][17][18][19] Our study has weaknesses and strengths, in part shared by other clinical studies on CKD and pregnancy. This study is based on the data collected by two centers alone.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16] Other diseases such as IgA or reflux nephropathy usually display a good prognosis, at least in the presence of normal kidney function. [17][18][19][20][21][22][23] Despite rising interest, few large cohorts of nonselected patients with CKD encompassing the most frequently encountered disorders in clinical practice are available.…”

mentioning

confidence: 99%

Risk of Adverse Pregnancy Outcomes in Women with CKD

Piccoli¹,

Cabiddu²,

Attini³

et al. 2015

Journal of the American Society of Nephrology

299

335

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CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (.1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; "general" combined outcome (preterm delivery, NICU, SGA); and "severe" combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4-5: "general" combined outcome, 34.1% versus 90.0%; "severe" combined outcome, 21.4% versus 80.0%; P,0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a "baseline risk" for adverse pregnancy-related outcomes linked to CKD.

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“…We also analyzed pregnancy outcomes by histologic subtype in a subset of papers that correlated renal histology with maternal and/or fetal outcomes (11,13,15,16,19,22,29,31,36). Because of limited data, we grouped histologic subclasses into proliferative (classes III and IV), and nonproliferative (classes II and V) lesions.…”

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

546

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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Pregnancy in women with pre-existing lupus nephritis: predictors of fetal and maternal outcome

Cited by 196 publications

References 29 publications

Systemic Lupus Erythematosus and Outcomes in First and Subsequent Births Based on Data From a National Birth Registry

Systemic Lupus Erythematosus and Outcomes in First and Subsequent Births Based on Data From a National Birth Registry

Risk of Adverse Pregnancy Outcomes in Women with CKD

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

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