Article Text

PDF
FRI0410 The Impact of Pregnancy on Lupus Flares in Korean Patients with Systemic Lupus Erythematosus: 15-Year Experience, Single-Center Study
  1. J. Koh1,
  2. Y.S. Suh1,
  3. J.H. Lee1,
  4. J. Lee1,
  5. S.M. Jung1,
  6. S.-H. Park1,
  7. S.-K. Kwok1,
  8. J. Kim2,
  9. J.Y. Lee1,
  10. H.Y. Kim3,
  11. J.Y. Kang1
  1. 1Rheumatology, Seoul St. Mary's hospital, Seoul
  2. 2Rheumatology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu
  3. 3Rheumatology, Konkuk University Hospital, School of Medicine, Seoul, Korea, Republic Of

Abstract

Background Systemic lupus erytematosus (SLE) is a multi-organ autoimmune disease that affects women of childbearing age. SLE and lupus nephritis have more maternal and fetal complications than the general population. However, the impact of pregnancy on SLE activity is controversial in the literature, some studies reporting increased risk of lupus flare, while others indicate no increased risk.

Objectives The aims of this study were to investigate the effect of the pregnancy on disease status, both during the pregnancy and puerparium and the predictors for lupus flare. In addition, we examine lupus activity and pregnancy outcomes in lupus pregnancies continued, discontinued or not treated with Hydroxychloroquine (HCQ) during pregnancy.

Methods We performed a retrospective analysis of 183 pregnancies in 132 SLE patients managed in Catholic University Medical Center, Korea, between 1998 and 2012. Clinical profiles and maternal and fetal outcomes were assessed for this study population. Lupus flare was assessed with SLEDAI score. Discontinued HCQ group was defined as cessation of HCQ treatment within the 3 months prior to pregnancy. Not treated with HCQ from pre-pregnancy was defined cessation of HCQ treatment beyond 3 months prior to pregnancy.

Results The pregnancies were divided into 2 groups: experienced lupus flare (84 pregnancies) and not experienced lupus flare (99 pregnancies). 87.4% of pregnancies had successful delivery. There were significantly more preeclampsias (27.4% vs. 7.1%, with and without lupus flare, respectively, P <0.001), preterm births (44% vs. 16.7%, P=0.01), low birth weight (2.42±0.60 kg vs. 2.85±0.54 kg, P<0.001), intrauterine growth retardation (38.6% vs. 18.9%, P=0.006) and low 1 minute Apgar score (25.7% vs. 8.9%, P=0.004) in pregnancies with lupus flare. Lupus flares were predicted by discontinuation of HCQ (OR=4.968, 95% CI, 1.114-22.145; p=0.036), history of lupus nephritis (OR, 4.417; 95% CI 1.253-15.575, p=0.021), active disease status at conception (OR, 4.526; 95% CI, 1.276-16.049; p=0.019), high serum uric acid level (OR, 2.624; 95% CI, 1.414-4.868; p=0.002) and C4 level at pre-pregnancy (OR 0.858, 95% CI 0.762-0.966; p=0.011).

Conclusions Our study indicates that achieving remission before pregnancy and continuing HCQ treatment during pregnancy are important to prevent lupus flare during pregnancy.

References

  1. Stojan G and Baer AN. Flares of systemic lupus erythematosus during pregnancy and the puerperium: prevention, diagnosis and management. Expert review of clinical immunology. 2012; 8: 439-53.

  2. Lateef A and Petri M. Management of pregnancy in systemic lupus erythematosus. Nature reviews Rheumatology. 2012; 8: 710-8.

  3. Stanhope TJ, White WM, Moder KG, Smyth A and Garovic VD. Obstetric nephrology: lupus and lupus nephritis in pregnancy. Clinical journal of the American Society of Nephrology: CJASN. 2012; 7: 2089-99.

  4. Ateka-Barrutia O and Khamashta M. The challenge of pregnancy for patients with SLE. Lupus. 2013; 22: 1295-308.

  5. Clowse ME. Lupus activity in pregnancy. Rheumatic diseases clinics of North America. 2007; 33: 237-52, v.

  6. Petri M. Sex hormones and systemic lupus erythematosus. Lupus. 2008; 17: 412-5.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.2483

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.