Abstract
Flare of Systemic Lupus Erythematosus (SLE) may occur during pregnancy and puerperium. We studied the prevalence and factors associated with SLE relapse during pregnancy and post-partum period in a multi-ethnic SLE cohort. Consecutive SLE patients who attended the outpatient clinic were reviewed for previous history of pregnancies in our institution. Patients who had a complete antenatal, delivery, and post-partum follow up were included. Their medical records were retrospectively analysed to assess the disease activity at pre-pregnancy/conception, during antenatal, and post-partum period. Presence of flare episodes during pregnancy and puerperium were recorded. The pregnancy outcomes recorded include live birth, foetal loss, prematurity and intra-uterine growth restrictions (IUGR). Univariate and multivariable logistic regression with generalized estimating equations (GEE) analyses were performed to determine the factors associated with disease relapse and the pregnancy outcomes. A total of 120 patients with 196 pregnancies were included, with a live birth rate of 78.6%. Four (2.0%) were diagnosed to have SLE during pregnancy. The flare rate in pregnancy was 40.1% while post-partum 17.4%. Majority of the relapse in pregnancy occurred in haematological system (62.3%) followed by renal (53.2%), musculoskeletal (22.1%), and mucocutaneous (14.3%). In GEE analyses, active disease at conception was the independent predictor of SLE relapse during and after pregnancy, whereas older maternal age and Malay ethnicity were associated with higher flare during post-partum. HCQ use was significantly associated with reduced risk of flare in univariate analysis but it was no longer significant in the GEE analyses. Presence of disease flare in pregnancy was significantly associated with prematurity. In conclusion, pregnancy in SLE need to be planned during quiescent state as pre-pregnant active disease was associated with disease relapse in both during and after pregnancy. Malay patients had an increased risk of post-partum flare but further larger prospective studies are needed to confirm the association between pregnancies in the different ancestral background.
Highlights
Systemic lupus erythematosus (SLE) is an autoimmune disease which commonly affects young women in their reproductive age [1]
It is very imperative to delineate the risk of flare in SLE patients so that appropriate pre-pregnancy counselling and antenatal care can be personalized. This was a cross-sectional study conducted from January 2016 until December 2018 on consecutive SLE patients who attended the outpatient Rheumatology and Nephrology Clinic in Universiti Kebangsaan Malaysia Medical Center (UKMMC)
Antiphospholipid syndrome (APLS) tend to occur among patients with Indian and Arab ethnic group (p = 0.03) and they significantly had a higher history of recurrent miscarriages 1 (p = 0.04)
Summary
Systemic lupus erythematosus (SLE) is an autoimmune disease which commonly affects young women in their reproductive age [1]. It is characterized by production of autoantibodies resulting in inflammation of multiple organs with a relapse remitting pattern [2]. Despite favourable outcome of pregnancy among SLE patients [5], it continues to pose a significant challenge as the effect of pregnancy on SLE activity are still debatable in the literature This is because the nature of SLE itself is a relapse-remitting disease and most of the studies had lack of controls for direct comparisons
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