Background Woman with systemic lupus erythematosus (SLE) have 2 to 3 times higher risk of reactivation during pregnancy. However, the predictive factors of lupus flare in pregnancy are not completely elucidated.
Objectives To identify predictors of flare in pregnant women with SLE.
Methods We reviewed clinical records of a cohort of pregnant women with SLE (ACR 1982, 1997) treated in our Clinic of Pregnancy and Rheumatic Diseases in a tertiary referral center for the period January 2005 to June 2011. Patients were evaluated at least once during each trimester and once postpartum. Primary endpoint was lupus flare including specific skin lesions, arthritis, hematological, neurologic, cardiopulmonary and renal manifestations. We analyzed 15 clinical and laboratory variables that potentially have predictive value for lupus flare during pregnancy, including age, duration of disease, activity of SLE before pregnancy, renal function, organ involvement, parity, drug use and immunological parameters. For analysis each pregnancy was included as an independent event and these were divided into 2 groups: those of mothers who relapsed and those who did not. Statistical analysis included descriptive statistics, chi square, Student t test, bivariate and multivariate analysis; odds ratios (OR) with confidence intervals (CI) 95% were also calculated.
Results We studied 124 pregnancies in 120 women with a mean age of 26.5±5.1 years at time of pregnancy, with an mean of SLE evolution 5.2±4.1 years, 45 (36.2%) patients had lupus nephritis before pregnancy, 16 (12.9%) women had SLE activity before pregnancy, 47 (37.9%) women had at least one episode of flare during pregnancy. The significant variables associated with lupus flare during pregnancy in bivariate and multivariate analysis are shown in the table.
The live birth rate was similar in both groups (80.9% vs 87%, p=0.35); on the other hand, the rate of prematurity was higher (55.3% vs 35.1%, p=0.02) with fewer weeks of gestation (34.6±3.9 vs 35.8±3.4, p=0.009) in women who relapsed.
Conclusions According to the experience of our center, primiparous woman with SLE and hypocomplementemia before conception (lupus subclinical activity data) have a higher risk of relapse during pregnancy.
Disclosure of Interest None Declared