Pregnancy outcomes among Chinese women with and without systemic lupus erythematosus: a retrospective cohort study

Abstract

ObjectiveTo completely and quantifiably determine the effect of systemic lupus erythematosus (SLE) on pregnancy outcomes in a Chinese cohort.DesignA retrospective cohort study.SettingData were collected at a tertiary medical centre located in Shanghai, China, from September 2011 to May 2017.ParticipantsWe assigned 338 pregnant women with SLE to the study cohort and 1014 randomly selected pregnant women without SLE (three for every woman with SLE) to a comparison cohort. The relevant medical records of all pregnant women were retrospectively reviewed. Cases of multiple pregnancy and cases in which an artificial abortion was performed for personal reasons were excluded.Primary and secondary outcome measuresMaternal and fetal outcomes were primary outcomes, and management of antenatal care was the secondary outcome.ResultsThe risks of pregnancy-induced hypertension (OR 2.68, 95% CI 1.75 to 4.09), pre-eclampsia (OR 3.13, 95% CI 1.95 to 5.03) and premature rupture of membranes (OR 2.53, 95% CI 1.46 to 4.40) were significantly different between women with and without SLE. Gestational diabetes was negatively associated with SLE in pregnant women (OR 0.49, 95% CI 0.28 to 0.85). Pregnant women with SLE displayed significantly higher rates of fetal loss (OR 10.23, 95% CI 5.08 to 20.59), including spontaneous abortion (OR 4.42, 95% CI 1.52 to 12.80), therapeutic abortion (OR 16.57, 95% CI 5.80 to 47.35) and stillbirth (OR 13.25, 95% CI 1.49 to 118.11), and a higher risk of preterm birth (OR 3.15, 95% CI 2.21 to 4.50), intrauterine growth restriction (OR 2.20, 95% CI 1.35 to 3.58), a child who was small for the gestational age (OR 1.86, 95% CI 1.11 to 3.13), a caesarean section (OR 4.73, 95% CI 3.30 to 6.80) or a neonatal intensive care unit admission (OR 3.48, 95% CI 2.21 to 5.48) than women in the non-SLE population after adjusting for confounding factors.ConclusionsIn this study, SLE significantly increased the risk of adverse pregnancy outcomes. Therefore, a preconception assessment and close antenatal monitoring by both rheumatologists and obstetricians should be performed in pregnant women with SLE.

The study of factors associated with pregnancy outcomes in patients with systemic lupus erythematosus

“…The previous studies have been reported the relapse rates ranged from 13 to 68%. Generally, the frequency of outcomes evaluated in this study is within the reported range from other studies [15][16][17].…”

Pregnancy in systemic lupus erythematosus

“…FGR is also a known risk in pregnancies complicated by SLE. Recently, Chen et al found a significant increase in the risk of FGR in women with SLE (aOR 2.24, 95% CI [1.85-2.71]; Chen et al, 2020), which is consistent with prior studies (Chakravarty, Nelson, & Krishnan, 2006;Smyth et al, 2010;Wu, Ma, Bao, Di, & Zhang, 2018). Although there are numerous etiologies of FGR, including intrauterine infections, chromosomal anomalies, and multiple gestations, FGR due to placental insufficiency in women with SLE is common (Gluhovschi, Gluhovschi, Petrica, Velciov, & Gluhovschi, 2015).…”

Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: A prospective cohort study

“…in contemporary studies. [8][9][11][12]29,[54][55][60][61][62][63] In addition, a recently published Canadian study showed that the use of antimalarial drugs was stopped in up to 30% of patients during pregnancy. That is why we believe that our results reinforce the importance of maintaining antimalarial drugs during pregnancy.…”

“…[2][3][4][5] In retrospective, prospective or population-based studies, preeclampsia has been reported between 10% and 30% of pregnancies in SLE patients. [6][7][8][9][10][11][12][13] The importance of preeclampsia consists of the fact that it is a complication associated with high maternal and fetal morbidity and mortality, mainly in developing countries. 14 In addition, an increased risk of future cardiovascular complications in both newborns and women complicated with preeclampsia has been reported.…”