395. Possibility of corticosteroids to induce premature rapture of membrane in patients with systemic lupus erythematosus

Abstract

Introduction It is mentioned that premature rapture of membrane (PROM) occurs with higher rate in women with systemic lupus erythematosus (SLE), when compared to general population. Most of women who have SLE need to continue corticosteroids during their pregnancies. The relationships between PROM and corticosteroids are not well known, but a recent report in mice showed that corticosteroids weakened fetal membranes, which induced PROM. Hypothesis Here we hypothesize that corticosteroids induce PROM. Methods We reviewed all pregnancies delivered after 22 completed weeks’ gestation in patients with systemic lupus erythematosus (SLE) who were seen at National Center for Child Health and Development from 2005 to 2016. We sum up the dosage of corticosteroids given during pregnancy, and evaluated the relationship with pregnancy outcomes by univariable analyses. Results Forty-eight pregnancies in 48 women were identified. 47 women except one took corticosteroids during their pregnancy. 31% women received immunosuppressants at the same time. PROM occurred in 11 (22.9 percent). Sum of corticosteroids during the pregnancy was significantly bigger in PROM group than that of non-PROM group (central value (interquartile range)) (2730 (1862, 3570) mg v.s. 1890 (1259, 2590) mg; p = 0.031). Furthermore, the risk of PROM was increased in the frequency with increasing of corticosteroids dose. The amount of corticosteroids at the beginning of pregnancy and immunosuppressants didn’t show relationships with PROM. The rate of chorioamnionitis didn’t show significant difference between PROM group and non-PROM group. Discussion Possibility of risk that the more corticosteroids during pregnancy induce the more PROM was identified, and PROM in our study didn’t show relationship with chorioamnionitis. Possibility of corticosteroids to induce PROM in non-infectious etiology is suggested. Further evaluation is needed to seek out for the better management for pregnancies with SLE.