Abstract
Objective: Pregnancies of women with systemic lupus erythematosus (SLE) are associated with preterm delivery. As preterm delivery is associated with long-term neurological morbidity, we opted to evaluate the long-term neurologic outcomes of offspring born to mothers with SLE regardless of gestational age. Methods: Perinatal outcomes and long-term neurological disease of children of women with and without SLE during pregnancy were evaluated. Children of women with and without SLE were followed until 18 years of age for neurological diseases. Generalized estimating equation (GEE) models were used to assess perinatal outcomes. To compare cumulative neurological morbidity incidence a Kaplan–Meier survival curve was used, and a Cox proportional hazards model was used to control for confounders. Result: A total of 243,682 deliveries were included, of which 100 (0.041%) were of women with SLE. Using a GEE model, maternal SLE was noted as an independent risk factor for preterm delivery. The cumulative incidence of long-term neurological disease was not found to be significantly higher when using the Kaplan Meier survival curves and maternal SLE was not found to be associated with long-term neurological disease of the offspring when a Cox model was used. Conclusion: Despite the association of SLE with preterm delivery, no difference in long-term neurological disease was found among children of women with or without SLE.
Highlights
Systemic lupus erythematosus (SLE) is a chronic multisystemic autoimmune inflammatory disease with a wide range of clinical manifestations and it affects many organ systems [1]
Preeclampsia, fetal growth restriction, preterm delivery, cesarean delivery and postpartum infections [9,11,12] are some of the obstetrical complications shown to be correlated with SLE
As preterm delivery has been demonstrated to be associated with maternal age [22], and hypertensive disorders [23,24], after using a Generalized estimating equation (GEE) model controlling for maternal age and hypertensive disorders, maternal SLE was independently associated with preterm delivery
Summary
Systemic lupus erythematosus (SLE) is a chronic multisystemic autoimmune inflammatory disease with a wide range of clinical manifestations and it affects many organ systems [1]. Antiphospholipid antibodies (aPL) are the main predictors of pregnancy complications, including miscarriage, fetal death, prematurity and preeclampsia, with lupus anticoagulant (LAC) being strongly associated with miscarriage and late fetal loss [6,7,8]. Infants of mothers with SLE who were exposed to anti-Ro/SSA or antiLa/SSB antibodies during pregnancy have shown an increased risk for neonatal lupus syndrome, with its most serious manifestation being fetal heart block [6,9,10]. Preeclampsia, fetal growth restriction, preterm delivery, cesarean delivery and postpartum infections [9,11,12] are some of the obstetrical complications shown to be correlated with SLE
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