Pregnancy Outcome in Systemic Lupus Erythematosus (SLE) is Improving: Results from a Case Control Study and Literature Review

Abstract

Abstract:Objectives: For women who suffer from systemic lupus erythematosus (SLE), pregnancy can be a concern, placing the mother and fetus at risk. Our objectives were to assess the risk of adverse pregnancy outcome, disease flares, fertility rate, and co-morbidities in SLE women compared to healthy controls. We also systematically reviewed the literature available on pregnancy outcome in SLE to compare our results to other published data. Our hypothesis was that pregnancy outcome in SLE is improving over time.Methods: A case-control study comparing self-report of the above-mentioned parameters in SLE (N=108) vs healthy controls or patients with non-inflammatory musculoskeletal (MSK) disorders (N=134) was performed. Data were collected using a self-administered questionnaire. Proportions, means and odds ratios were calculated. We searched and quantified the literature on pregnancy outcome, lupus reactivation and fertility rate. Data were summarized and presented in mean % ± SEM and median % with interquartile range (IQR).Results: Gynecological history, fertility rate and age at first pregnancy in SLE patients were comparable to controls. Eighteen percent of SLE patients reported a flare and 18% reported an improvement of symptoms during pregnancy. Twenty-four percent of lupus patients had at least one preterm delivery vs 5% in controls (OR =8.32, p = 0.0008), however other pregnancy outcomes (miscarriage, therapeutic abortion, stillbirth and neonatal death rate) did not differ between the groups. Thyroid problems were reported to be more likely in SLE patients (p = 0.02), but the prevalence of other co-morbidities was similar to controls. A literature review demonstrated that fertility was not affected in SLE patients. Lupus reactivations are common during pregnancy (36.5% ± SEM 3.3%). Most agreed that SLE pregnancies had more fetal loss (19.5% ± SEM 1.6%) and preterm births (25.5% ± SEM 2.2%) when compared to the general population. Over time, the rate of SLE peripartum flares has improved (p = 0.002) and the proportion of pregnancies resulting in live birth has increased (p = 0.024). The frequency of fetal death has not significantly changed. Our findings from the casecontrol study were, in general, consistent with the literature including the frequency of fetal death, neonatal death, live births and pregnancy rate.Conclusion: Prematurity (25.5% ± SEM 2.2%) and fetal death (19.5% ± SEM 1.6%) in SLE pregnancy are still a concern. However, new strategies with respect to pregnancy timing and multidisciplinary care have improved maternal and fetal outcome in SLE.

Brief Report: Causes of Stillbirths in Women With Systemic Lupus Erythematosus

“…As mentioned above, prior studies have shown that women with SLE are at an increased risk of certain placenta-mediated pregnancy complications (e.g., preeclampsia, late pregnancy loss, and SGA) (1,2). Anomalies in placental pathology are commonly found in women with SLE (both in the presence and absence of antiphospholipid antibodies [aPL]), including frequent hypoxicischemic change, decidual vasculopathy, and lower-thanexpected placental weight (for gestational age).…”

“…Observational studies of pregnant women with SLE, most retrospective in design and including a limited number of subjects, have shown a wide-ranging prevalence of stillbirths, with estimates between 1% and 3% (1). In addition, these studies have mainly been conducted in tertiary care centers, and have not directly compared stillbirths occurring in women with SLE to a general population control group.…”

Serum markers thrombophilia in pregnant women with Systemic Lupus Erythematosus

“…22 Maternal lupus activity and the presence of antiphospholipid antibodies were associated with concomitant major causes of obstetric complications, 12,22 It is estimated that approximately 20% of pregnancies in women with SLE result in fetal loss. 23 The rate of preterm birth (birth before 37 weeks gestation) is also increased in this group of patients. The incidence appears to vary between 23% and 28%.…”

“…The incidence appears to vary between 23% and 28%. 23 Preterm birth is often spontaneous, and it is mainly due to premature rupture of membranes, but there is also a significant portion of cases in which labor is induced to protect the health of mother and / or baby (early fetal distress or preeclampsia). 19 In relation to serum markers of hereditary thrombophilia, protein C deficiency, S and antithrombin, we found an incidence of 40% (10/25) among pregnant women with lupus, however several authors, 9,24,25 did not find the presence of these markers in non-pregnant patients with SLE, suggesting that they were not associated with an increased thrombotic risk.…”

Prognosis in Pregnant Females With Systemic Lupus Erythematosus

“…Pregnancy can exacerbate lupus, and can even be life-threatening to mother and child. [5][6][7][8][9][10][11] In this study, we aimed to analyze the relationship between pregnancy and lupus, and explore the risk factors that adversely affect maternal and infant outcomes.…”