Extended report
Pregnancy in past or present lupus nephritis: a study of 32 pregnancies from a single centre
D Lê Thi Huonga, B Wechslera, D Vauthier-Brouzesb, H Beaufilsc, G Lefebvreb, J-C Piettea
a Department of
Internal Medicine (Pr Piette), Groupe Hospitalier
Pitié-Salpêtrière, 83 bd de l'Hôpital, 75013 Paris, France, b Department of Gynaecology and Obstetrics (Pr
Darbois), Groupe Hospitalier Pitié-Salpêtrière, c INSERM U
423, 75015 Paris
Correspondence to: Dr D Lê Thi Huong boutin.du{at}psl.ap_hop.paris.fr
Accepted for publication 25 January
2001
OBJECTIVE
To study
maternal and fetal outcome in women with past or present histologically
proven systemic lupus erythematosus (SLE) nephritis.
METHODRetrospective
study of 32 pregnancies in 22 women with past or present histologically
proven SLE nephritis in a single French centre.
RESULTSPregnancy (25 planned and 7 not planned) occurred in a mean (SD) of 8 (5) years after
SLE diagnosis and 6 (4) years after renal disease onset. Seven occurred
in women with antiphospholipid syndrome. At pregnancy onset, all but
one woman had creatininaemia below 100 µmol/l, five had proteinuria
>0.5 g/day, none had hypertension. Twelve pregnancies occurred in
women previously treated with immunosuppressant drugs. Treatment
comprised prednisone (n=31), hydroxychloroquine (n=11), aspirin (n=22),
heparin (n=12), and azathioprine in one patient with steroid resistant
nephrotic syndrome disclosing SLE. No therapeutic abortion was done.
During pregnancy or the postpartum period, or both, proteinuria
>0.5 g/day occurred in 10 women (five related to pre-eclampsia, four
to renal flare, one to stable nephrotic syndrome). One flare consisted
of mild arthralgias. Pregnancy outcome comprised one feto-maternal
death in SLE disclosed by pregnancy, five embryonic losses, two fetal
deaths, and 18 premature (one neonatal death) and six full term births.
No criterion appeared to influence fetal survival significantly. At
long term, one patient died during an SLE flare, three women had renal
relapses. At the last visit, all had creatininaemia below 100 µmol/l
except one woman with creatinine level 115 µmol/l, nine had
proteinuria >0.5 g/day, and one was treated for hypertension.
CONCLUSIONPregnancy
need not be discouraged in women with a history of SLE nephritis with
normal or mildly impaired renal function. Deterioration of renal
function rarely occurs. However, these pregnancies are at high risk of
pre-eclampsia and prematurity.
© 2001 by Annals of the Rheumatic Diseases
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