Prospective Study of Pregnancy in Systemic Lupus Erythematosus. Results of a Multidisciplinary Approach

Mintz, G; Niz, José; Gutiérrez, Gustavo Romero; Garcia-Alonso, Angel; Karchmer, S

doi:10.1097/00006254-198742050-00008

Cited by 109 publications

(116 citation statements)

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“…Although controversial, several prospective studies have shown increased disease activity during pregnancy, ranging from 30% to 70% [20][21][22][23]. The risk of lupus flares is higher if the woman has had active disease in the 6 months prior to pregnancy [1].…”

Section: Discussionmentioning

confidence: 99%

Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy

et al. 2012

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Previous reports suggest that renal involvement before pregnancy or active renal disease during pregnancy may be associated with poor fetal and maternal outcomes in systemic lupus erythematosus (SLE) women. We report our experience of fetal and maternal complications in pregnant lupus women with and without previous lupus nephritis. We analyzed the clinical records of pregnant SLE patients attended in a tertiary reference center during a 5-year period. Patients were allocated into two groups according to the presence or absence of previous lupus nephritis. Women were evaluated monthly during pregnancy and at least 1 month postpartum. Maternal and fetal outcomes of pregnancy were abstracted. We included 95 pregnancies in 92 patients. Compared with pregnant women without lupus nephritis (n = 60), pregnancies with previous lupus nephritis (n = 35) were associated with a higher risk of maternal complications (88.5% vs. 43.3%, p = 0.00001), higher rate of lupus flares (54.2% vs. 25%, p = 0.004), and renal flares (45.7% vs. 6.6%, p = 0.00001), but most of which in most instances were reversible. On the other hand, fetal outcome was similar in both groups. Multivariate analysis showed that previous lupus nephritis and active lupus at conception were predictors of adverse maternal outcome. Pregnancies in women with previous lupus nephritis had a higher rate of maternal complications in comparison with those without. However, fetal prognosis was similar in both groups.

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Section: Discussionmentioning

confidence: 99%

Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy

et al. 2012

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“…18,24 Lupus nephritis flare Studies from 1970 through 1992 have included 276 women who had a diagnosis of lupus nephritis pre-pregnancy; 133 (48%) had an exacerbation of renal disease during pregnancy, with many developing nephrotic-range proteinuria. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] However, a more recent multi-centre retrospective study reporting renal and pregnancy outcomes of 113 pregnancies in 81 women with lupus nephritis found renal flare affected only 15% of pregnancies and in 15% of women up to a year post-partum. 42 Flares were more common in women with active disease pre-pregnancy, in partial remission, those with proteinuria >1 g/24 hours or with a glomerular filtration rate (GFR) <60 ml/min/1.73 m 2 .…”

Section: Disease Activity During Pregnancymentioning

confidence: 99%

Pregnancy and renal outcomes in lupus nephritis: an update and guide to management

Bramham

Soh

Nelson‐Piercy

2012

Lupus

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Systemic lupus erythematosis (SLE) commonly affects women of child bearing-age, and advances in treatment have resulted in an increasing number of women with renal involvement becoming pregnant. Knowledge of the relationship of the condition with respect to fertility and pregnancy is important for all clinicians involved in the care of women with lupus nephritis because they have complicated pregnancies. Presentation of lupus nephritis can range from mild asymptomatic proteinuria to rapidly progressive renal failure and may occur before, during, or after pregnancy. The timing of diagnosis may influence pregnancy outcome. Pregnancy may also affect the course of lupus nephritis. All pregnancies in women with lupus nephritis should be planned, preferably after more than six-months of quiescent disease. Predictors of poor obstetric outcome include active disease at conception or early pregnancy, baseline poor renal function with Creatinine >100 μmol/L, proteinuria >0.5 g/24 hours, presence of concurrent antiphospholipid syndrome and hypertension. In this review the most recent studies of pregnancies in women with lupus nephritis are discussed and a practical approach to managing women prepregnancy, during pregnancy and post-partum is described.

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“…Fetal adrenal suppression is rare [99]. Intrauterine growth retardation with CS use during pregnancy has not been reported in several studies [94,100] and in others may be a reflection of the underlying maternal disease [101].…”

Section: Corticosteroidsmentioning

confidence: 99%

Rheumatoid Arthritis and Reproduction

Golding

Haque

Giles

2007

Rheumatic Disease Clinics of North America

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Prospective Study of Pregnancy in Systemic Lupus Erythematosus. Results of a Multidisciplinary Approach

Cited by 109 publications

References 0 publications

Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy

Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy

Pregnancy and renal outcomes in lupus nephritis: an update and guide to management

Rheumatoid Arthritis and Reproduction

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