Morbidities in pregnancy associated with systemic lupus erythematous

Abstract

The association between systemic lupus erythematosus (SLE) and pregnancy is not a rare event, but these pregnacy are associated with an increased risk of preeclampsia, fetal growth restriction, fetal stillbirth, prematurity and neonatal death. Nephritis is an important complication of SLE and a factor for maternal and fetal morbidity. Studies of the impact of SLE and pregnancy morbidities generate conflicting results. The aim of these study was to realize a systematic analysis in the literature concerning the pregnancy outcome in women with SLE and SLE associated with lupus nephritis. We searched the electronic database in literature and random effects of analytycal methods were used to evaluate pregnancy complications rates. Also the association between pregnancy and nephritis it is not very often encountered in different articles. Active SLE and the presence of antiphospholipid antibodies (APA) are considered the most powerful predictors of perinatal morbidity. We found that a significant number of pregnancies occur during periods of active nephritis (19%), and have positive APAs (26.2%). Up to 75% of patients with SLE have clinically evident renal disease. Lupus flare in pregnancy is one of the major issues associated with SLE. However, studies report variable flare rates in pregnancy between 25-65%. Other important perinatal complications associated with SLE in pregnancy are: gestational hypertension (16.3%), fetal growth restriction (12,7%), preeclampsia (7,6%), preterm delivery (39,4%), stillbirth (3,6%), neonatal death (2,5%). Neonatal lupus syndromes is a form of passively acquired fetal autoimmunity from maternal antibodies, anti-Ro and anti-La antibodies with important cardiac involvement, most commonly congenital heart block. Previous and actual lupus nephritis is associated with negative effects on preganancy and with a deterioration of renal function. Despite considerable improvement in success rates, suboptimal obstetrical outcomes still remain a cause for concern. Best pregnancy results can be obtained if appropriately managed by a multidisciplinary team of physicians.