Background Most previous studies reported less successful fetal outcome and more frequent maternal obstetric complications in systemic lupus erythematosus (SLE) pregnancy, whereas the impact of pregnancy on SLE remains controversial. On the other hand, because there have been only a few small published studies focusing the pregnancy outcome in Japanese patients with SLE, available information is currently still insufficient for Japanese women and their partners.
Objectives We aimed to investigate the pregnancy outcome in Japanese patients with SLE in more than twice larger size than previous reports.
Methods The questionnaires about past pregnancies were delivered to all the Japanese women with SLE seen at our university clinic in November and December 2013. All the patients met the revised ACR classification criteria for SLE. Respondents were asked to answer the questionnaires while referring to the Maternal and Child Health Handbook, which consists of records of pregnancy, delivery, child development, and healthcare, and is filled in by obstetricians, pediatricians, and public health nurses. Clinical and laboratory data were also retrospectively collected from the medical records. Integrated data were statistically analyzed and also compared to available corresponding data in general Japanese populations.
Results A total of 77 patients answered about 134 pregnancies: 18, 7, and 109 pregnancies occurred before, concomitant with, and after SLE diagnosis, respectively. In cases with pregnancies after SLE diagnosis, SLE was clinically quiescent in 105 of 109 pregnancies. Of the 116 pregnancies concomitant with or after SLE diagnosis, 81 (70%) resulted in a live birth, 14 (12%) in induced abortion, 19 (16%) in spontaneous abortion, and 2 (2%) in stillbirth. Among the 81 live births, low birth weight (LBW), fetal growth restriction (FGR), and preterm birth occurred in 43 (53%), 9 (11%), and 27 (33%) pregnancies, respectively. In general Japanese populations, these incidences were reported to be 10%, 3 to13%, and 5 to 13%, respectively. Although immunosuppressants other than steroids, namely tacrolimus, cyclosporine, and azathioprine, were continued during 9 pregnancies, these incidences were not significantly different compared to those without immunosuppressants. Of the 7 live birth pregnancies before SLE diagnosis, there were no LBW, FGR, or preterm birth. Of all, there were 2 cases of neonatal lupus. Of the 116 pregnancies concomitant with or after SLE diagnosis, pregnancy-induced hypertension (PIH) occurred in 24 (21%) pregnancies, which reportedly occurred in 3 to 5% in general Japanese populations. Maternal obstetric complications (including PIH and excluding SLE flare) more frequently occurred in the pregnancies concomitant with or after SLE diagnosis than in the pregnancies before SLE diagnosis (49/116 vs. 3/18, p =0.04). Of the 109 pregnancies after SLE diagnosis, 16 (15%) pregnancies were associated with SLE flares, but their predictors were not clarified.
Conclusions The present study showed that LBW, preterm birth, and maternal obstetric complications such as PIH were associated with SLE pregnancies among Japanese women. Concurrent use of tacrolimus, cyclosporine, and azathioprine during pregnancy was not associated with poor fetal outcome. SLE flares occurred in 15% of the pregnancies, but their predictors were not clarified.
Disclosure of Interest None declared
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