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.
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Disclosure of Interest None declared