Lupus Nephritis and Pregnancy

Abstract

Objective: To record fetal and maternal outcome in pregnancies with systemic lupus nephritis.Subjects: Twelve pregnancies in 11 women with lupus nephritis were studied. All patients were followed during the entire term of the pregnancy and for 6 months postpartum. The laboratory studies performed included antinuclear antibody titer (ANA), anti-DNA antibody titer, complement component levels (C3 and C4), lupus anticoagulant, anticardiolipin antibody, serum creatinine, 24-h urine protein, partial thromboplastin time, VDRL, and tests of hematopoietic and hepatic function.Main Outcome Measures: Antenatal and postnatal complications of lupus nephritis, proteinuria, hypertension, preterm delivery, birthweight, and perinatal mortality.Results: Twenty-five percent of pregnancies resulted in fetal loss, 58% in premature delivery, and 17% in term delivery. There were no neonatal deaths. All patients conceived during a period of clinical remission. Flares of systemic lupus erythematosus (SLE) occurred in four patients. Maternal renal function deteriorated in 25% of the pregnancies but this was reversible in all cases. Increased proteinuria was recorded in 58% of the pregnancies and was irreversible in two women (17%). Hypertension occurred in 42% of the pregnancies, but permanent hypertension postpartum was recorded in only one patient (8%).Conclusions: SLE nephritis remains a high-risk condition for pregnancy. Preeclampsia, prematurity, and fetal growth retardation frequently complicate these pregnancies, and infant morbidity is high. Patients should avoid pregnancy until all manifestations of nephritis are quiescent.