Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia

Abstract

We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a 10-year period (2006–2015) to describe the clinical features, maternal and foetal outcomes in our centre. There were 115 pregnancies in 86 women with SLE. Our patients had a mean age of 29.1 years (SD 5.80) and a mean disease duration of 44.63 months (SD 41.17). Fifteen patients had antiphospholipid syndrome (APS). Our patients had complicated pregnancies: 26.1% had SLE flares, 13.9% had pre-eclampsia and 45.1% needed caesarean sections. There were 23.3% foetal losses and 25% preterm deliveries in our patients. There was a higher rate of unplanned pregnancies and lupus flare among pregnancies with active SLE at conception. Pregnancies in lupus nephritis have higher incidence of lupus flares during pregnancy but similar maternal and foetal outcomes compared to those without nephritis. The prognostic indicators for adverse foetal outcome in our patients were flare of SLE (HR 4.08 [CI 95% 1.65–10.13, p < 0.01]) and APS (HR 3.07 [CI 95% 1.12–8.42, p < 0.05]) and the prognostic indicator for adverse maternal outcome was hypertension (HR 3.58 [CI 95% 1.30–9.90, p < 0.05]). Lupus pregnancies in our centre remained as high-risk pregnancies with significant maternal and foetal complications.

Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia

“…In patients with quiescent disease prior to pregnancy, the flare rate is estimated at 5–30% but it can go up to 75% among patients with active disease [50, 54]. Despite a more robust association between LN and disease relapse in pregnancy [7, 9, 25, 31, 46, 48, 55–57], our study did not demonstrate any significant association between them. Two studies with predominant Caucasian patients also observed no significant increase risk of disease activity among their LN patients as compared to non-pregnant controls [58], and the incidence of renal flare during pregnancy and 6 months after delivery was similar to that observed before pregnancy [45].…”

“…In our cohort, the rate of relapse was approximately 40% and this was lower than those reported in the earlier reported rate of 40–75% in the literatures published before the year 2000 [6–8, 10]. The rate of flare in pregnancy continued to decline in the year 2000–2010, ranging from 13–40% [9, 13, 40, 45, 46], and majority of the reports from 2010 onwards demonstrated lower flare episodes of less than 30% [28, 47, 48]. The reported post-partum relapses were even lower, ranging from 4.9–20% [13, 49–51].…”

“…Interestingly our study found that Chinese patients had a higher rate of flares during pregnancy while Malay patients had an increase risk of relapse during post-partum period. This observation can be explained by the fact that Chinese patients tend to have prior renal involvement and the literature reported a higher risk of relapse in patients with prior history of LN [7, 9, 11, 48, 62]. There are considerable differences in the post-natal practices among different ethnics in Malaysia [63].…”

Management and outcomes of pregnancy with or without lupus nephritis: a systematic review and meta-analysis

“…There were two articles that studied PROM, 13 , 19 both of which showed no significant difference between pregnant women with LN and those without LN. The same result was found regarding GDM.…”

“…The same result was found regarding GDM. 19 , 20 Saavedra et al found that more pregnancies with LN had evidence of active disease at conception (25.7% vs 6.6%, P =0.009), and active disease at conception was a predictor for any type of maternal complication (OR=16.4, 95% CI=1.97–137.2, P =0.01). 13 Carmona et al did not identify any differences between the two groups.…”