Pregnancy and fetal outcomes in patients with lupus nephritis

Abstract

To determine risk factors for pregnancy and fetal outcomes in patients with lupus nephritis during pregnancy and postpartum, 26 patients with 34 pregnancies between 1986 and 2004 were reviewed retrospectively. Of the 34 pregnancies, we observed 23(67.6%) live births at term, 5(14.7%) premature births, 2(5.9%) spontaneous abortions and 4(11.8%) artificial abortions. After exclusion of artificial abortions, live birth rate was 93.3%; it was not significantly difference versus 88.1% in 197 pregnancies without nephritis. But in pregnancies with active nephritis, there were an increased number of pre-term deliveries (57.1% vs. 4.8%). Frequency of flare was analyzed in 30 pregnancies with lupus nephritis by trimester and postpartum. In addition to 7 flares that occurred in the postpartum, 8 flares occurred during pregnancy (3[20%] in the first trimester, 3[20%] in the second trimester, 2[13%] in the third trimester). There was higher rate of flare compared to that 115 lupus patients with 129 pregnancies between 1986 and 2001 (50% vs. 22.5%). Renal flare in 29 pregnancies was 6(20.7%), three flares occurred in the first trimester, 3 in the second trimester. In the analysis of laboratory data of 28 pregnancies at onset of pregnancy, fetal gestational age significantly associate with proteinuria, plasma creatinine level and SLEDAI, fetal birth weight significantly associate with proteinuria and plasma creatinine level. Of the 34 pregnancies, 11 underwent renal biopsy prior to pregnancy, pregnancy and fetal outcomes were poorly in the class IV patients. In conclusion, pregnancy is safe for the majority of mothers if it is planned when lupus nephritis is quiescent.