Background Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder that disproportionally affects women, especially in their reproductive years. SLE is associated with considerable pregnancy-related morbidity, including fetal loss, preterm birth and preeclampsia. Multiple factors are associated with adverse pregnancy outcomes in SLE including ethnicity, renal involvement and glucocorticoid exposure prior to the pregnancy (1,2). The factors associated with adverse pregnancy outcomes vary among patients from different ethnic backgrounds. Few studies have been performed in Hispanic populations and none in Mexicans.
Objectives To determine the frequency and associated factors of pregnancy outcomes in women with SLE from a Mexican cohort.
Methods 100 SLE women (≥16 years) from a Mexican cohort from 2011 to 2013 were examined. SLE cases fulfilled 4 of SLICC 2012 criteria and pregnancies occurring after SLE diagnosis. Adverse pregnancy outcome was a miscarriage or abortion (<20 weeks), a stillbirth (> or =20) and preterm-baby (<34 weeks); good pregnancy outcome was a full-term baby [C-section or vaginal delivery (38-42 weeks)]. Demographic factors, comorbidities and pharmacologic treatments were examined for SLE patients without and with pregnancy, mainly for adverse and good pregnancy outcomes. Variables were examined by univariable and multivariable analyses.
Results Of 100 SLE women 14 had pregnancy; of them 7 were adverse pregnancy outcomes including 5 abortions and 2 preterm-babies. The other 7 pregnancies with good outcome, six were C-section and one vaginal delivery full-term babies. The mean age [standard deviation (SD)] for pregnancy women was 29.8 (1.46) years and for no pregnancy women was 40 (1.49) years. Pregnancy was more common in the age group from 26 to 35 years. In univariable analyses patients with good pregnancy outcomes were more likely to be younger, to have more body mass index, higher blood platelets counts, to use less methotrexate, lower doses of glucocorticoids and more frequently to employ azathioprine, chloroquine and aspirin. On the other hand previous preeclampsia, none fetal monitoring, renal involvement and mycophenolate mofetil use were associated with adverse pregnancy outcomes. No differences were found for SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC). In the multivariable analyses, to have more body mass index (OR 0.77, 95% CI 0.62-0.97, p=0.026), higher blood platelets counts (OR 0.98, 95% CI 0.97-0.99, p=0.044), and lower dose of glucocorticoids used prior to the pregnancy (OR 0.29, 95% CI 0.26-0.90, p=0.033) remained significant as protective factors.
Conclusions This study suggests that previous preeclampsia, none fetal monitoring, renal involvement and mycophenolate mofetil use were associated with adverse pregnancy outcomes and more body mass index, higher blood platelets counts and lower dose of glucocorticoids used prior to the pregnancy remained significant as protective factors. No differences were found for variables related to activity or damage accrual of SLE. However, these observations must be confirmed in larger and prospective studies with more rigorous methodology.
Clin Exp Rheumatol. 2008 Mar-Apr;26(2):268-741.
Rheumatology (Oxford). 2006 Nov;45(11):1380-42.
Disclosure of Interest None declared