Background: Systemic lupus erythematosus is a chronic autoimmune disease often affecting women in fertile age. The physiological changes in T-helpers (Th1/Th2) activity balance during pregnancy can cause SLE flare. Women with SLE are at high risk for maternal and fetal complications. The high SLE activity is associated with higher risk of PE and lower birth weight, compared with population controls. Nevertheless, no detailed analysis of the relationship between clinical features/laboratory parameters and unfavorable pregnancy outcome in patients with SLE has been carried out in the recent studies.
Objectives: This study aimed to analyze influence of SLE activity, laboratory parameters and medications on risk of maternal and fetal complications.
Methods: A retrospective single-center cohort study 11/2014-12/2018: 43 pregnancies in 42 patients with proved SLE and > 20 weeks of gestation, mean age was 31,5 years. Renal function at conception and after delivery, pregnancy outcomes, clinical and laboratory parameters were collected. PE was diagnosed by the 2008 WHO criteria. The sFlT/PlGF ratio was used as the main differential marker to exclude lupus nephritis exacerbation in cases of increased proteinuria.
Age of the patients, SLE activity, hemoglobin and platelet levels, glomerular filtration rate, serum creatinine, AST, ALT, fibrinogen, D-dimer, aPTT, antinuclear factor and antiphospholipid antibodies concentrations, the using/non-use of glucocorticoids, hydroxychloroquine, low molecular weight heparins and aspirin were analyzed as potential risk factors of unfavorable pregnancy outcomes: PE, premature delivery, low birth weight, low Apgar score at 1 and 5 minutes after birth.
Results: In 12 cases (27.9%) there was no activity of SLE, in 16 cases (37.2%) there was low activity, in five (11.6%) – moderate, in three (7%) – high, in seven cases (16.3%) SLE activity was not assessed. SLE activity showed significant negative correlation with week at which labor occurred (p = 0.003, R = –0.477) and birth weight (p = 0.005, R = – 0.461) and we found a significant fivefold increase in preeclampsia in patients with high activity of SLE (p = 0.011, OR = 4.95, 95% CI 1.449 to 16.931). Hemoglobin levels in third trimester correlated positively with birth weight (p = 0.04, R = 0.322). The dosage of glucocorticoids showed a significant correlation with week of delivery (p = 0.011, R = -0.382). Interestingly, the increase of aPTT in. the third trimester had an almost significant effect on the risk of developing PE (p = 0.059, OR = 1.237, 95% CI 0.958-1.596). Unfortunately, lupus anticoagulant (LA) at that moment was not measured. Other studied parameters were not associated with risk of PE.
Conclusion: High SLE activity significantly increases the risk of gestational complications and unfavorable pregnancy outcomes. We suggest that regular monitoring of antiphospholipid antibodies, especially LA, is needed. In this study, laboratory parameters did not significantly affect the risk of PE.
References  Zhang J.J. et al. A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy//Clin. J. Am. Soc. Nephrol. 2015. V. 10. No 11. P. 1964–1978.
 Skorpen C.G. et al. Influence of disease activity and medications on offspring birth weight, pre-eclampsia and preterm birth in systemic lupus erythematosus: A populationbased study//Ann. Rheum. Dis. 2018. V. 77. No 2. P. 264–269.
 Wu J. et al. Therapeutics and Clinical Risk Management Dovepress Management and outcomes of pregnancy with or without lupus nephritis: a systematic review and meta-analysis//Ther. Clin. Risk Manag. 2018. P. 14–885.
 Lightstone L., Hladunewich M.A. Lupus Nephritis and Pregnancy: Concerns and Management//Semin. Nephrol. 2017. V. 37. No 4. P. 347–353.
Disclosure of Interests: None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.