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FRI0406 Maternal and Fetal Outcomes in Pregnant Systemic Lupus Erythematosus Patients: an Incident Cohort from A Stable Referral Population Followed during 1990-2010
  1. I.M. Jakobsen1,
  2. R.B. Helmig2,
  3. K. Stengaard-Pedersen1
  1. 1Rheumatology, Aarhus University Hospital, Aarhus C
  2. 2Obstetrics and Gynaecology, Aarhus University Hospital, Skejby, Aarhus N, Denmark

Abstract

Background Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and remains an important contributor to maternal and fetal morbidity and mortality (1) in spite of advances in the treatment of both SLE and obstetric complications for the past decades. Antiphospholipid syndrome and presence of antiphospholipid antibodies, decreased kidney function and disease activity in general have been shown as risk factors for spontaneous abortion, premature delivery, IUGR and fetal death (1,2,3). The reported frequency of SLE flares during and after pregnancy varies in the literature from 25-68%. In Danish patients the impact of pregnancy on SLE activity and fetal complications have not been studied, and Scandinavian data on the subject is scarce (4).

Objectives To assess the impact of SLE and presence of autoantibodies on pregnancy outcome in a cohort of incident pregnant lupus patients referred to a Danish university hospital during 1990-2010.

Methods All pregnant lupus patients were referred to the university hospital from a stable referral area with approximately 1.4 million inhabitants. 84 pregnancies in 39 women were registered using the Danish National Registry and by retrospective reviewing of medical records, laboratory results, and midwifes' records from the Department of Rheumatology and the Department of Obstetrics and Gynaecology and possible other departments. Data was compared to data from 29,059 births during 2005-2010, covering all births from the referral area.

Results The 84 SLE pregnancies resulted in 62 live births. SLE flares developed in 46.4%, preeclampsia in 8.3%, HELLP syndrome in 4.8% of cases. Significantly higher rates of premature delivery (p=0.0032), Caesarean section (p=0.015), hypertension (p=0.025) and IUGR (p=0.003) were found. Disease activity significantly (p=0,021) increased the risk of prematurity 3-fold. Presence of antiphospholipid antibodies significantly (p=0,002) increased the risk of spontaneous abortion 3-fold. Two babies died after extreme preterm birth. Two had neonatal lupus syndrome, and one had congenital heart block. Birth weight and length were significantly lower in the SLE cohort. An unexpectedly high number of cardiac septum defects in the babies was observed.

Conclusions Danish women with SLE have a higher frequency of adverse pregnancy outcome for both the baby and the mother compared to the general population, but most SLE pregnancies were successful. A high number of babies born with cardiac septum defects were found and this needs further research.

References

  1. Ostensen M, Clowse M. Pathogenesis of pregnancy complications in systemic lupus erythematosus. Curr Opin Rheumatol 2013;25(5):591-596.

  2. Empson M, Lassere M, Craig J, Scott J. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev 2005;(2)(2):CD002859.

  3. Cortes-Hernandez J et al. Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: a prospective study of 103 pregnancies. Rheumatology (Oxford) 2002;41(6):643-650.

  4. Julkunen H, et al. Fetal outcome in lupus pregnancy: a retrospective case-control study of 242 pregnancies in 112 patients. Lupus 1993;2(2):125-131.

Acknowledgements Financial support from the Institute of Clinical Medicine, Aarhus University Hospital made this study possible.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.4655

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