Background The issue of pregnancy in systemic lupus erythematosus (SLE) is very complex. The risk of relapse of the underlying condition and the involvement of fetus of a mother with SLE is substantially increased.
Objectives The goal of this long-term project was to investigate the course of pregnancy in patients with SLE with or without secondary antiphospholipid syndrome (APS) in 1993-2013, to describe the type and severity and to explore their relationship with disease-related characteristics. To find specific histological changes in maternal tissue of a subgroup of patients.
Methods During 20 years of systematic observation 210 pregnant women with SLE and with/or without APS were observed and examined. Patients were evaluated every 3 months by a rheumatologist and gynaecologist. Basic demographic data were assessed, as well as the duration and type of immunosuppressive agents, corticosteroid dose, autoantibodies, organ involvement and its activity, the number and type of disease flares, thrombosis, the number of abortions and premature labours, new-born weight and presence of complications such as gestational diabetes, hypertension and preeclampsia. In a subgroup of 18 patients a macroscopic and histological examination of maternal tissue was performed in comparison with a healthy control group.
Results The group comprised 210 pregnant women with SLE, out of which 28% had secondary APS. 90% of patients were treated with oral corticosteroids, 8% with cyclosporine A and 13% with azathioprine, 20% with low molecular weight heparin and 40% with salicylates. 8% of pregnancies were terminated in the first trimester due to missed abortion. 6% of abortions in patients with secondary APS in second trimester were observed. 180 SLE patients delivered 186 newborns, 15% of them before the 37th week of pregnancy and 5% before the 34th week. Out of this group 70% patients delivered prematurely due to hypertension or preeclampsia, 10% due to growth retardation of fetus. Newborn weight was 3020g on average. AV heart block of 3rd degree was observed in 4 newborns. No congenital malformations were observed in our group. A higher number of gestational diabetes was found: 33% of patients, all of which were treated with corticosteroids. Hypertension was found in 35% patients, preeclampsia in 11% and 50% of patients with preeclampsia had a history of lupus nephritis. Lupus activity as evaluated by SLEDAI score was 5 points on average in the beginning of pregnancy, and 10 points after delivery. In a group with abortions, average SLEDAI was 12. A higher score of maternal infarcts and decidual pathological changes with deposits of immunocomplexes were found in microspopical examination in patients with APS or with antiphospholipid antibodies positivity.
Conclusions In spite of the fact that women with SLE have a high risk during the course of pregnancy, the results of our 20 years study showed a good outcome of pregnancy. In our cohort systematic cooperation between rheumatologist and obstetrician was of vital importance.
Acknowledgements Supported by Research Project Ministry of Health of Czech Republic NO: 000 000 23728.
Disclosure of Interest None declared