Pregnancy outcome in systemic lupus erythematosus patients: a monocentric cohort analysis

Abstract

Objective SLE is an autoimmune disease, mainly affecting women of childbearing age, with possible impact on pregnancy. In this study, we evaluated pregnancy outcomes in all pregnant patients affected by SLE, followed in the context of a rheumatology/gynaecology multi-disciplinary team. Methods Since 2008, we evaluated 70 consecutive pregnancies occurring in 50 SLE patients referring to the Lupus Clinic of Sapienza University of Rome; as controls we evaluated 100 consecutive pregnancies in 100 women without autoimmune diseases. Results By comparing SLE patients and controls, we did not find differences in terms of pregnancy outcomes, except for the occurrence of small for gestational age, which was significantly higher in the SLE group (22.8% vs 11%, P =0.003). Small for gestational age was associated with the positivity for anti-dsDNA, anti-Sm and anti-RNP (P =0.009, P =0.02, P =0.002, respectively). A disease flare was reported in 28 pregnancies (40%) and in 31 puerperium periods (44.3%). Flare during pregnancy was associated with anti-SSA (P =0.02), while puerperium relapse with previous MMF treatment (P =0.01) and haematological flare during pregnancy (P =0.03). Conclusion The present study confirms how pre-gestational counselling and a multi-disciplinary approach could result in positive pregnancy outcomes for SLE patients. The high percentage of disease relapse justifies even more the need for multi-disciplinary management.

Preparing for Pregnancy in Women with Systemic Lupus Erythematosus—A Multidisciplinary Approach

“…Overall, results showed a reduction in maternal mortality and unfortunate pregnancy outcomes in mothers with SLE, most likely as a consequence of improved disease-pregnancy timing. Similar results were found in other cohorts, too [ 22 , 23 , 24 , 25 , 26 ].…”

Effect of Tacrolimus vs Intravenous Cyclophosphamide on Complete or Partial Response in Patients With Lupus Nephritis

“…Although not assessed in this study, the potential for longer term treatment-related adverse effects should be considered when selecting the most appropriate initial therapy in patients with LN. In this context, the apparent lack of ovarian toxic effects with tacrolimus is an advantage over IVCY, which has been shown to be associated with an increased risk of premature ovarian failure in patients with SLE . However, whether tacrolimus is associated with long-term kidney toxic effects in LN—as has been suggested in transplantation—may also be a consideration .…”

“…Combination therapy with high-dose corticosteroids and intravenous cyclophosphamide (IVCY) is an established initial therapy among patients with LN . However, CY is cytotoxic, and serious adverse effects have been observed during long-term treatment, including premature ovarian failure …”

Use of gonadotropin-releasing hormone agonists for ovarian preservation in patients receiving cyclophosphamide for systemic lupus erythematosus: A meta-analysis

“…7–12 In addition, other factors such as low neutrophil counts, temporary amenorrhea during treatment, greater SLE-related damage accrual, as measured by Systemic Lupus International Collaborating Clinics (SLICCs) scores > 1, and presence of anti-Sm, anti-RNP, and anti-cardiolipin antibodies have also been associated with higher incidence of CYC related gonadotoxicity. 13–15 Cyclophosphamide is a cytotoxic medication used in the treatment of organ-threatening or life-threatening SLE. Furthermore, the use of CYC can result in fewer successful pregnancies with a higher risk of fetal miscarriage and preterm delivery.…”