Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE): A Retrospective Study of 109 Pregnancies.

Ming Ku,Qing Li,Shuiming Guo,Weifeng Shang,Rui Zeng,Gang Xu,Min Han,Shuwang Ge,Courtney G Montgomery

doi:10.1371/journal.pone.0159364

Ming Ku, Qing Li + Show 7 more

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https://doi.org/10.1371/journal.pone.0159364

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Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects women during their reproductive years. The interaction between SLE and pregnancy remains debated. The objective of this study was to analyze the fetal and maternal outcomes of Chinese women with SLE. A total of 109 pregnancies in 83 SLE patients from June 2004 to June 2014 at a tertiary university hospital were reviewed retrospectively. Patients’ characteristics, clinical and laboratory data during pregnancy were obtained from electronic medical records. After exclusion of elective abortions, the live birth rate was 61.5%. Significantly, APS (antiphospholipid syndrome), disease activity, hypertension, hypocomplementemia, thrombocytopenia, and anemia during pregnancy were more commonly observed in fetal loss pregnancies than in live birth pregnancies. Compared to the 64 women with a history of SLE, 19 women with new-onset lupus during pregnancy had worse pregnancy outcome. Furthermore, the 64 patients with a history of SLE were divided into lupus nephritis group and SLE group (non-renal involvement). We found that the lupus nephritis group had worse maternal outcome than the SLE group. We conclude that new-onset lupus during pregnancy predicts both adverse maternal and fetal outcomes, while a history of lupus nephritis predicts adverse maternal outcomes. It is essential to provide SLE women with progestational counseling and regular multispecialty care during pregnancy.

Highlights

Systemic lupus erythematosus (SLE) is a complex, multisystem disease that mainly attacks fertile women
Characteristic Age at disease onset Age at conception Disease duration First pregnancy Second pregnancy Third or more pregnancy Cesarean section SLEDAI-2K at conception New onset SLE Neonatal lupus Neonatal heart disease antiphospholipid syndrome (APS) Laboratory features at onset of pregnancy antinuclear antibodies (ANA) Anti-dsDNA Anti-Ro/SSA Anti-La/SSB Anti-Sm aCL Hypocomplementania complement 3 (C3) complement 4 (C4) Drugs taken at the onset of pregnancy prednisone Aspirin Azathioprine Cyclophosphamide Methotrexate chloroquine
We found that lupus nephritis pregnancies have more maternal adverse outcomes, including proteinuria, hypertension, disease activity and SLE flares, compared to SLE group

Summary

Introduction

Systemic lupus erythematosus (SLE) is a complex, multisystem disease that mainly attacks fertile women. Women with lupus disease are not less fertile than unaffected women, but SLE may increase pregnancy complications, including spontaneous abortion, premature delivery, intrauterine growth restriction (IUGR), and preeclampsia[1]. SLE and Pregnancy associated with significant fetal and maternal complications[8–10]. Several studies suggested that renal function and the presence of proteinuria at the time of conception may contribute to adverse maternal and fetal outcomes[7,11–13]. New-onset of SLE can even occur during pregnancy [13,18,19]. A study suggested that new-onset SLE during pregnancy generally occurred during the second trimester, with a higher rate of renal and blood involvement[20]. There are limited researches associated with the new-onset of SLE during pregnancy and its impacts on the pregnancy outcomes

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