Transactions from the 71st Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society
Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus

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Objective

The purpose of this study was to describe the outcomes of a 10-year cohort of pregnancies in patients with systemic lupus erythematosus and to evaluate clinical and laboratory markers for adverse outcomes.

Study design

We reviewed all pregnancies in patients with systemic lupus erythematosus who were seen at Stanford University from 1991 to 2001. Univariate analyses were performed to identify potential risk factors for adverse outcomes.

Results

Sixty-three pregnancies in 48 women were identified. Approximately 35% of the pregnancies occurred in women with previous renal disease and 10% in women with previous central nervous system disease. Flares occurred in 68% of the pregnancies, the majority of which were mild to moderate. Preeclampsia complicated 12 pregnancies. Factors that were associated with premature delivery included prednisone use at conception (relative risk, 1.8), the use of antihypertensive medications (relative risk, 1.8), and a severe flare during pregnancy (relative risk, 2.0). Thrombocytopenia was associated with an increased risk of preeclampsia (relative risk, 3.2).

Conclusion

Flares, most of which were mild to moderate, occurred most of the pregnancies in our cohort of patients with systemic lupus erythematosus. Thrombocytopenia, hypertension, and prednisone use may be predictive factors for particular adverse outcomes.

Section snippets

Material and methods

With the approval of the institutional review board, the medical records from all the pregnant patients with SLE who were seen at Stanford University Hospital and Lucile Packard Children's hospital between 1991 and 2001 were reviewed. All patients met at least 4 of the 1997 Revised American College of Rheumatology criteria for SLE.17, 18

Baseline maternal information included age, past obstetric history, duration of SLE, previous and current manifestations of SLE, and medications. Active disease

Results

Sixty-three pregnancies in 48 patients with lupus were seen at Stanford University and Lucille Packard Children's Hospitals between 1991 and 2001. Twenty patients were white; 11 patients were Hispanic; 11 patients were Asian; 2 patients were black, and 4 patients were classified as Other. Most of the patients (81%) had 1 pregnancy within the time period under study. Six patients had 2 pregnancies, 2 patients had 3 pregnancies, and 1 patient had 6 pregnancies. Three pregnancies resulted in twin

Maternal outcomes

Maternal pregnancy outcomes are listed in Table II. Patients with a diagnosis of SLE during pregnancy experienced worse maternal outcomes, with severe flares occurring in all and preeclampsia occurring in 2 of 4 patients. Most of the patients (68%) experienced a flare of SLE during the pregnancy; however, most of these flares were mild to moderate in nature, with articular, cutaneous, and constitutional manifestations that did not necessarily require changes in medications. Severe flares

Fetal outcomes

Fetal outcomes of pregnancies are listed in Table III. Six pregnancies ended in spontaneous abortion during the first trimester. There were no second or third trimester pregnancy losses. More than one half of the live births were premature (<37 weeks of gestation), most of which were between 32 and 37 weeks of gestation. Sixteen of 29 preterm births were spontaneous, most of which were due to preterm premature rupture of membranes (PPROM) between 32 and 37 weeks of gestation. The remainder of

Comment

Pregnancy outcomes for patients with SLE have improved in recent decades because of better care during the preconception and prenatal periods; however, maternal and fetal complications still occur. Despite an extensive and growing body of literature that evaluates the relationships between SLE and pregnancy, there remains a lack of consensus about the impact of pregnancy on maternal lupus and the impact of maternal lupus on pregnancy outcomes. The differences in outcomes between studies have

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    Presented at the 71st Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society, October 19-24, 2004, Phoenix, Arizona.

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