Risk of adverse pregnancy outcomes in Japanese systemic lupus erythematosus patients with prior severe organ manifestations: A single-center retrospective analysis

Abstract

Background Systemic lupus erythematosus (SLE) increases the incidence of adverse pregnancy outcomes (APOs). Nevertheless, most of the data on SLE pregnancies were derived from database studies in which details of the pregnancies were unavailable, and no consensus exists on the risk of APO in patients with prior severe organ manifestations. Methods SLE patients followed by rheumatologists and gynecologists throughout pregnancy at our institute were retrospectively identified, and their data between April 2003 and December 2020 were reviewed from electronic records. We assigned patients based on the presence of prior severe organ manifestation (renal/neurological manifestation, prior treatment with methylprednisolone pulse therapy/prednisolone 1 mg/kg/day/biological or cytotoxic therapy) and compared the incidence of overall and serious APO (maternal death, pregnancy loss, preterm birth <32 weeks, birthweight <1500 g, Apgar score <7 at 5 min and birth defect). Results This study included 34 pregnancies in 32 patients; 23 pregnancies in 22 patients were classified as SLE with prior severe organ manifestation. There was no statistical difference in the incidence of overall APO between the two groups (52.2% vs 45.5%, P = 1). Among patients with prior severe organ manifestation, 17.4% had serious APO. A detailed electronic health record search revealed specific causes of APO in all pregnancies with serious APO, except the presence of prior severe organ manifestation. Conclusion The incidence of overall APO in SLE patients was not affected by prior severe organ manifestation. Although the incidence of serious APOs increased in patients with previous severe organ manifestation, there were other risk factors for poor pregnancy outcomes besides prior lupus severity. Therefore, proper management by rheumatologists and gynecologists may enable patients with prior severe organ manifestation to safely deliver healthy babies.

Immunological disease activity parameters at conception are risk factors for preterm birth and low birth weight in patients with systemic lupus erythematosus

“…[1][2][3][4][5] Previous studies have shown that a high disease activity, antiphospholipid antibodies, lupus nephritis, and the glucocorticoid dose are risk factors for these APOs. [6][7][8][9][10][11][12][13][14][15][16] We have also shown that disease activity parameters and glucocorticoids were associated with APOs and the Apgar scores of newborns. 11,16 Thus, uncontrolled disease activity and its parameters, such as complement or anti-doublestranded DNA (anti-dsDNA) antibodies, are strongly related to APOs, and the strict control of SLE disease activity in women with SLE who hope to become pregnant is required.…”

“…[1][2][3][4][5] Additionally, these APOs are associated with a high disease activity, lupus nephritis, antiphospholipid antibodies, and glucocorticoid dose during pregnancy. [6][7][8][9][10][11][12][13][14][15][16] Clowse et al found that APOs were increased in patients with high SLE disease activity during pregnancy, particularly for PB (61% with high disease activity compared with low disease activity, p < 0.001). 6 In recent years, several reports have shown an association between APOs and various parameters of disease activities, such as serological biomarkers.…”

Safety of tacrolimus use during pregnancy and related pregnancy outcomes in patients with systemic lupus erythematosus: A retrospective single-center analysis in Japan

“…According to a recent review of APOs in SLE pregnancies, 18 the percentages for maternal and fetal complications during pregnancy that were reported in previous studies were as follows: HDP, 0.99%–45%; GDM, 0%–11%; preeclampsia, 5.8%–17%; preterm birth, 9%–56%; miscarriage, 0.4%–18%, SGA, 10%–28.5%; and Apgar score < 7 at 5 min, 0%. Pregnancy outcomes in our institution were therefore within reasonable ranges when compared to those in previous studies.…”

Glucocorticoid discontinuation in patients with SLE with prior severe organ involvement: a single-center retrospective analysis

“…Therefore, reduction of glucocorticoid dosage is recommended according to the 2016 EULAR guidelines for use of antirheumatic drugs before and during pregnancy and lactation38 and the 2020 ACR guideline for management of reproductive health in rheumatic and musculoskeletal diseases 39. As we have previously proven that patients with SLE can have favourable pregnancy outcomes even with prior severe organ involvement,40 glucocorticoid discontinuation may further improve pregnancy outcomes.…”