Background Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder that primarily affects women of childbearing age. Pregnancy with SLE is associated with many complications. Therefore, the patient's SLE disease activity needs to be managed as low as possible during pregnancy.
Objectives The aim of this study is to examine the pregnancy outcomes in patients with systemic lupus erythematosus and the effect of SLE flare and treatment on pregnancy outcomes.
Methods Data of 67 pregnancies of 59 SLE pdtients were analyzed retrospectively. Univariate analysis using chi-square test and logistic regression was used to assess the predictive value of each variable on binary outcomes. Lupus activity was based on SLE Pregnancy Disease Activity Index (SLEPDAI) criteria.
Results During pregnancy, the disease activity was defined active in 62,69% of the pts. Termination of pregnancy was performed in 6 patients - indications were severe active lupus nephritis (5 cases) and dead fetus in utero (1 case). The relapse rate during pregnancy was 29,85%. In 22 cases disease activity was continued from the pre-pregnancy period. There were 5 elective, 4 spontaneous abortions, and 1 stillbirth, with 57 pregnancies resulting in live births including one multiple gestation. Preterm deliveries were significantly more frequent in patients with lupus nephritis, anti-Ro/SSA antibodies, hypertension, impaired renal function at the time of conception, preeclampsia/eclampsia, history of intravenous cyclophosphamide treatment and aPL than those without these features. Neonates with intrauterine growth retardation were more common in hypertensive, lupus nephritis and Raynaud's-positive pregnancies. One fetal malformation (atrial septal defect) was recorded. Among 15 pregnancies with SLE that were in active stage at conception, 80% deteriorated during pregnancy. Of the 55 pregnancies that were stable at conception, 49,09% flared during pregnancy or postpartum. Preeclampsia/eclampsia, active lupus nephritis, impaired renal function were significantly associated with preterm birth; preeclampsia/eclampsia and thrombocytopenia were also significant predictors of maternal SLE flare-up. Prednisolone was found to improve the rate of live births, although it was also a predictor of prematurity.
Conclusions Normal renal function, controlled blood pressure, the absence of lupus nephritis, aPL and anti-Ro/SSA antibodies are predictors of favorable fetal outcomes. The risk for flare may be a function of the disease activity prior to pregnancy. It is important to carefully plan pregnancy, and experienced rheumatologists and obstetricians should monitor SLE patients in pregnancy and postpartum.
Disclosure of Interest None declared
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