FRI0227 PREGNANCY OUTCOMES IN A LONG-TERM FOLLOW-UP COHORT OF PEDIATRIC ONSET SYSTEMIC LUPUS ERYTHEMATOSUS (PSLE) AT A TERTIARY CARE CENTER IN NORTH-WEST INDIA

Abstract

Background: Pediatric-onset SLE (pSLE) represents 10–20% of all SLE cases, and is associated with more severe disease as compared to adult onset SLE. pSLE patients are known to have more frequent systemic involvement especially related to kidneys, central nervous system and musculoskeletal system(1). Pregnant women with SLE have increased risk of adverse outcomes including disease flare, spontaneous abortion, preeclampsia/eclampsia, premature birth and maternal death(2). There is paucity of literature in pregnancy outcomes among women with pediatric onset SLE, especially from developing countries Objectives: To evaluate pregnancy outcomes in a long term follow up cohort of pediatric SLE patients from a tertiary care center in North India Methods: We have reviewed our previously published cohort of 27 pSLE patients who were diagnosed as SLE between 1998 and 2003. They were being followed-up at Pediatric Rheumatology Clinic, Advanced Pediatrics Centre, Postgraduate Institute of Medical education and research, Chandigarh, India. We have analyzed disease related complications, antiphospholipid antibody profile, pregnancy related complications and long-term outcomes in these patients. Results: Follow up records of 27 pSLE patients were retrieved from the clinical files. Data are available for 14 patients (i.e. 52% of the original cohort). Six (22%) of 14 patients expired due to disease related complications (2 had end stage renal disease, 1 had pulmonary thromboembolism, 2 had pulmonary hemorrhage, 2 had sepsis). Eight patients have been on follow-up till date with mean duration of follow-up of 20 years (range:16-25 years). Total patient years of follow up was 160 years. Of the 8 patients on follow up, renal manifestations were seen in 4(50%), neuropsychiatric in 4(50%), severe hematologic in 3(37.5%), musculoskeletal in 1(12.5%), aniphospholipid antibody (APLA) positivity in 3(37.5%) patients. Disease and therapy related complications were seen in 3 patients (obesity in 2, osteopenia and avascular necrosis of femur in 1, hypertension in 1). Eight pregnancies were observed in 5 of these patients; 1 patient had primary infertility. Mean age at first pregnancy was 19 years (range: 21-25 years). All 5 patients received hydroxychloroquine throughout the pregnancy and disease activity was well controlled. APLA testing was done in 2 patients during pregnancy and both tested negative. Five live births and 3 fetal losses were observed. The fetal losses were spontaneous first trimester abortions. None had eclampsia/pre-eclampsia, ectopic pregnancy or adverse fetal outcomes (prematurity, intrauterine growth restriction, heart defects). Conclusion: This is one of the longest follow-up studies in pSLE patients and probably the only one where pregnancy outcomes have been studied in a pediatric onset disease in context of a developing country. Our results show that in the presence of well controlled symptoms, pregnancy related outcomes are favorable with minimal fetal and maternal complications even in resource limited settings.