Pregnancy Related Complications in Patients with Systemic Lupus Erythematosus, An Egyptian Experience

Abstract

BackgroundSystemic Lupus Erythematosus (SLE) has a tendency to occur in women in their reproductive years, causing complications during pregnancy and labour. Conversely, pregnancy can cause flares of disease activity, often necessitating immediate intervention.Aim of studyto study pregnancy related complications in patients with SLE.Patients and methodsThe study included 48 SLE pregnant females. 27 patients with 38 pregnancies, their data viewed retrospectively from medical records, and 21 patients with 21 pregnancies followed up prospectively. The laboratory data included ANA, DNA, APL antibodies and anti Ro/SSA. The disease activity was calculated according to the Systemic Lupus Activity Measure. Ultrasound was performed to confirm gestational age and assess for the presence of any congenital fetal malformations, and then repeated monthly to detect any abnormality including intrauterine growth restriction. At 30 weeks gestation and onwards, assessment of fetal wellbeing including daily fetal kick chart and once weekly non stress test was performed. Doppler blood flow velocimetry was done for those with abnormal fetal heart rate pattern. After labour, the neonate was examined for complications including complete heart block and neonatal lupus.ResultsAnti dsDNA was found in 95% of the patients, anti Ro/SSA in 6% and anti APL in 30%. 57% of the patients followed up prospectively had active disease in the 1st trimester, 24% in the 2nd and 62% in the 3rd trimester. The most common maternal complication was preeclampsia 33%, followed by spontaneous abortion 20%. Prematurity was the most common fetal complication 37%, followed by intrauterine growth restriction 29%. 2 neonates were born with congenital heart block and 1 with neonatal lupus.ConclusionPregnancy in SLE patients is associated with a higher risk of obstetric complications affecting both the mother and the fetus. Preeclampsia was the most common complication followed by prematurity. Preeclampsia was significantly associated with third trimester disease activity.

Enhancing the care of women with rheumatic diseases during pregnancy: challenges and unmet needs in the Middle East

“…Numerous studies have shown that pregnancies in patients with rheumatic diseases are high risk, because of the potential for complications during periods of active disease [ 2 ]. Several studies have shown that pregnancy in these patients is associated with poor fetal outcomes [ 3 – 5 ]; for example, higher perinatal mortality rate was observed in mothers with chronic inflammatory arthritides, related to first birth [ 6 ]. In previous decades, female patients were sometimes advised against pregnancy due to the risk of disease flares and possible harmful effects of medications on the growing fetus and the newborn child [ 5 ].…”

“…However, these births had considerable complications (12 preterm babies; 8 with intrauterine growth restriction; 7 with low birth weight; 6 preterm infants admitted to neonatal intensive care unit, and 4 neonates died) [ 11 ]. Pregnancy complications were also reported in a retrospective analysis from 2011 [ 3 ]. These observations suggest that there is a need to improve the care and support of pregnant women with rheumatic diseases in the Middle East in order to improve pregnancy outcomes in these patients.…”

Caracterización de mujeres embarazadas con lupus eritematoso sistémico y resultados materno-fetales en el noroeste de Colombia. Estudio descriptivo

“…En cuanto a la afección lúpica al ingreso, las principales manifestaciones fueron articulares y mucocutáneas, resultados similares a otros estudios (9,24,26) ; aclaramos que la mayoría de las pacientes estaban en remisión al momento del ingreso a la cohorte. Durante el seguimiento las manifestaciones renales y cutáneas fueron las más frecuentes, similar a lo descrito por Petri et al, (27) , en una cohorte de 74 embarazos con pacientes de raza mixta, en la cual predominaron estas manifestaciones, además del compromiso articular, que en nuestra población no fue tan frecuente.…”

Pregnancy outcomes among Egyptian women with systemic lupus erythematosus: A prospective cohort study

“…4,5 The burden of maternal and fetal complications of pregnancy in SLE patients is still significant, 6,7 however, with good disease control, careful pregnancy planning, and multidisciplinary team (MDT) management, delivery of healthy babies is often possible. 8 There are limited studies on pregnancy outcomes in African SLE patients, 9,10 and therefore we embarked on this study to describe pregnancy outcomes among Egyptian women with SLE who were followed by an MDT and to identify predictors of adverse maternal and fetal outcomes.…”