Abstract
Objective To investigate the fetal and maternal outcomes as well as predictors of APOs in women with SLE who conceived when the disease was stable, the so-called “planned pregnancy.” Methods. A retrospective multicenter study of 243 patients with SLE who underwent a planned pregnancy was performed. APOs in fetus and mothers were recorded. Results The average age at conception was 28.9 ± 3.9 years. Duration of SLE prior to pregnancy was 4.4 ± 4.3 years. Fetal APOs occurred in 86 (86/243, 35.4%) patients. Preterm births, intrauterine growth retardation (IUGR), fetal distress, and fetal loss accounted for 22.2%, 14.8%, 11.1%, and 4.9%, respectively. Forty-two preterm infants (42/54, 77.8%) were delivered after the 34th week of gestation. All the preterm infants were viable. Fifty-two patients (52/243, 21.4%) had disease flares, among which 45 cases (45/52, 86.5%) were mild, 6 (6/52, 11.5%) were moderate, and 1 (1/52, 1.9%) was severe. Disease flares were mainly presented as active lupus nephritis (41/52, 78.8%), thrombocytopenia (10/52, 19.2%), and skin/mucosa lesions (9/52, 17.3%). Pregnancy-induced hypertension (PIH) occurred in 29 patients, among which 3 were gestational hypertension and 26 were preeclampsia. Multiple analysis showed that disease flares (OR, 8.1; CI, 3.8–17.2) and anticardiolipin antibody positivity (OR, 7.4; CI, 2.5–21.8) were associated with composite fetal APOs. Conclusion Planned pregnancy improved fetal and maternal outcomes, presenting as a lower rate of fetal loss, more favorable outcomes for preterm infants, and less severe disease flares during pregnancy.
Highlights
Compared with the general population, patients with SLE are still at high risk of adverse pregnancy outcomes (APOs) [1]
Two-thirds of the pregnancies ended in successful delivery without any fetal APOs and severe maternal disease flares occurred in only 0.4%
Our results showed that the rate of fetal loss was significantly decreased and the occurrence of moderate-to-severe disease flares was remarkably reduced in lupus patients who underwent planned pregnancy, preterm births remained an important issue
Summary
Compared with the general population, patients with SLE are still at high risk of adverse pregnancy outcomes (APOs) [1]. A number of studies have shown that patients with SLE are more likely to develop fetal complications, including fetal loss, preterm birth, and IUGR, compared to healthy women [2]. Recent studies have reported that fetal outcomes are relatively favorable if lupus is stable or mildly active [3]. Patients with SLE were advised to consider pregnancy during periods of inactive or stable disease [5], the so-called “planned. Such researches usually enrolled a small number of candidates, and data is lacking in China
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