Background Compared to the general population, pregnant women with systemic lupus erythematosus (SLE) tended to suffer a higher risk of adverse pregnancy outcomes (APOs). Since SLE often affected women of reproductive age, pregnancy outcomes and the associated factors had always been a major concern.
Objectives To investigate the maternal and fetal outcomes among pregnant patients with SLE, and to evaluate the clinical predictors of adverse pregnancy outcomes.
Methods We collected the clinical data from 251 SLE patients with 263 pregnancies between Jan 2001 to Dec 2015 and then conducted retrospective analysis. APOs included pregnancy loss (spontaneous or therapeutic abortion, fetal death, and neonatal death), adverse fetal outcomes [fetal malformation, preterm delivery, and neonatal lupus erythematosus (NLE)], obstetrical complications [pregnancy induced hypertension (PIH), intrauterine growth retardation (IUGR), and fetal distress]. Associated factors for APOs were analyzed by Logistic regression model.
Results The mean age of patients was 28.6±3.9 yrs, apart from newly diagnosed ones, the mean duration was 5.8±4.0 yrs. Of all the 263 pregnancies, 188 were from previously diagnosed SLE patients and 75 were from newly diagnosed (during pregnancy or puerperium) patients. Successful delivery and pregnancy loss occurred in 71.5% (188/263) and 29.5% (75/263), respectively. Pregnancy loss included therapeutic abortion in 60 (22.8%), spontaneous abortion in 6 (2.3%), fetal death in 7 (2.7%), and neonatal death in 2 (0.8%). Adverse fetal outcomes included 4 cases (1.5%) with fetal malformation, 56 (21.3%) with premature and 12 (4.6%) with NLE. Obstetrical complications included 35 cases (13.3%) with PIH, 32 (12.2%) with IUGR, 21 (8.0%) with fetal distress. Pregnancy loss in newly diagnosed SLE patients was significantly higher than those in previously diagnosed ones (45.3% vs. 21.8%; P<0.001). In multivariate analysis, hypocomplementemia (OR=3.60, 95%CI 1.30–9.94, P=0.01), hypoproteinemia (OR=3.21, 95%CI 1.23–8.30, P=0.02), antiphospholipid antibodies positivity (OR=8.393, 95%CI 1.73–40.84, P=0.01), anti-DNP antibody positivity (OR=5.64, 95%CI 1.24–28.36, P=0.03), and hypertension (OR=14.597, 95%CI 1.51–141.60, P=0.02) were independent risk factors for APOs. Usage of hydroxychloroquine (OR=0.27, 95%CI 0.11–0.73, P=0.01) during pregnancy was a protective factor for APOs.
Conclusions The rate of APOs is still high in SLE patients complicated with pregnancy. Pregnancy loss in newly diagnosed SLE patients is significantly higher than those in previously diagnosed ones. Hypocomplementemia, hypoproteinemia, antiphospholipid antibodies positivity, anti-DNP antibody positivity and hypertension are important risk factors for APOs. Usage of hydroxychloroquine during pregnancy is protective.
Disclosure of Interest None declared