Abstract
While the management of pregnant patients with systemic lupus erythematosus (SLE) has improved over the last decades, the risk of maternal, foetal, and neonatal complications is still substantial. We evaluated the occurrence of adverse pregnancy outcomes (APO) occurring in 2002–2018 among patients with SLE from the catchment area of the Department of Rheumatology in Lund, Sweden. Longitudinal clinical and laboratory data were collected and analysed. Results were stratified according to the sequence of conception. We investigated a total of 59 pregnancies in 28 patients. Prior lupus nephritis was the clinical feature that, in a multivariable regression analysis, displayed the strongest association with APO overall (OR 6.0, p = 0.02). SLE combined with antiphospholipid syndrome (APS) was associated with the risk of miscarriage (OR 3.3, p = 0.04). The positivity of multiple antiphospholipid antibodies (aPL) was associated with APO overall (OR 3.3, p = 0.05). IgG anti-cardiolipin during pregnancy resulted in a higher risk of preterm delivery (OR 6.8, p = 0.03). Hypocomplementaemia was associated with several APO, but only in the first pregnancies. We conclude that, despite the close follow-up provided, a majority of pregnancies resulted in ≥1 APO, but a few of them were severe. Our study confirms the importance of previous lupus nephritis as a main risk factor for APO in patients with SLE.
Highlights
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that often affects fertile women
Maternal Adverse pregnancy outcomes (APO) observed in SLE include increased disease activity, pre-eclampsia, eclampsia and Haemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome, as well as obstetrical complications, such as preterm labour, unplanned Caesarean delivery, and conditions related to pre-eclampsia [3,4,5]
The results of the present investigation highlight the risks of APO in SLE
Summary
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that often affects fertile women. Adverse pregnancy outcomes (APO), commonly grouped into maternal and foetal/neonatal complications, occur in the obstetric general population. Pregnant SLE patients are at increased risk of both maternal and foetal/neonatal APO [1,2]. Women with SLE are at increased risk of foetal loss around the 10th gestational week, in the presence of active SLE, active lupus nephritis (LN), or concomitant antiphospholipid syndrome (APS) [9]. Up to 30% of pregnancies in SLE patients are complicated by IUGR and small-for-gestational-age (SGA) newborns, compared to approximately 10% of pregnancies in the general obstetric population [13,14]. Pre-eclampsia is one of the most frequent maternal APO in SLE, occurring in 16% to 30%, compared with 5% of pregnancies in the general obstetric population [16,17]. Active SLE, previous LN, presence of APS or aPL, and thrombocytopenia have been suggested as predictors, as well as putative risk factors of other APO [16,20,21,22], but studies are needed to evaluate this further
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