Pregnancy Outcomes And Influence Factors Of Patients With Systemic Lupus Erythematosus

Objective:Systemic lupus erythematosus(SLE)is a systemic autoimmune disease involving multiple organ and systemic damage,especially occurs in women of childbearing age.Compared to healthy pregnant women,SLE patients have a higher incidence of preterm delivery,preeclampsia and fetal loss during pregnancy,and frequent exacerbations during late pregnancy and postpartum lactation may be related to estrogen and prolactin levels in the body.SLE flare usually occurs during pregnancy and postpartum,and multiple maternal and fetal diseases are also closely associated with SLE。It is important to monitor lupus disease activity and pharmacological reaction during pregnancy in SLE patients.The aim of this study was to evaluate risk factors for adverse pregnancy outcomes(APO)in patients with SLE and to find treatment options to improve the outcomes of pregnancy.Methods:Female patients with SLE of childbearing age were collected in rheumatology clinic of Qilu hospital from November 2018 to September 2021 and diagnosis with the 1997 ACR SLE criteria.All enrolled patients were given glucocorticoids and hydroxychloroquine as basic SLE drugs,or immunosuppressants such as tacrolimus cyclosporine,or anti-platelet anticoagulation therapy such as aspirin and/or low molecular heparin.At baseline,the patients’ disease duration,age,weight and BMI,previous adverse pregnancy history,blood routine,liver and kidney function,immunoglobulin and complement levels,antiphospholipid antibody(aPL)levels,and SLE disease activity score(SLEDAI)were recorded.They were followed-up since 3 months before pregnancy,every 4 weeks until postpartum.With the patients’ SLEDAI score,phospholipid antibody levels,medications and doses,and fetal ultrasound at the corresponding time points,we analyze risk factors for adverse pregnancy in SLE patients and identify treatment options that can improve prognosis and pregnancy outcomes.Results:115 patients completed follow-up from preconception to 45 days after delivery.49(42.6%)had a full-term delivery,51(44.3%)had a preterm delivery,and 15(13.1%)had a stillbirth.Thirty-nine(33.9%)had mild active SLE during pregnancy,and 76(63.1%)were in stable SLE.As a result,66(57.4%)cases were classified as abnormal pregnancy outcome(APO).Those with baseline SLEDAI ≤2 were less likely to have SLE activity during pregnancy than those with baseline SLEDAI>2.Twelve of those with a positive baseline combined aPL continued to be positive for aPL during pregnancy;17 of 103 with negative baseline aPL progressed to be positive during pregnancy.There was no significant correlation between combined/uncombined aPL antibody positivity and adverse ultrasound events and pregnancy outcome in SLE patients.Adverse ultrasound events during pregnancy are usually associated with maternal SLE activity,and timely detection of adverse ultrasound events before mid-pregnancy,increasing the dose of prednisone,and combining anticoagulation therapy with aspirin and low-molecular heparin can help to improve pregnancy outcome.Conclusion:The SLE patients with low SLEDAI were included in this study,and most of them stained stable during pregnancy.Patients with baseline SLEDAI ≤2 were less likely to relapse during pregnancy.In the fetus,maternal SLE activity leads to a series of adverse fetal ultrasound events.The probability of new aPL positivity during pregnancy was higher in those with abnormal pregnancy history.Whether combined with the aPL antibody or not,the adverse ultrasound events and pregnancy outcomes were no difference in SLE patients.If low-dose aspirin were given from preconception onwards,the incidence of APO and stillborn in patients with combined APS and history of multiple adverse pregnancies would decrease.In case of obstetric ultrasound adverse events happened,therapeutic doses of aspirin in combination with low-molecular heparin can improve placental function and fetal blood supply in a timely and effective manner.With regular review of SLE-related indicators and regular obstetric examinations during pregnancy,SLE disease activity and ultrasound abnormalities can be timely detection and effectively treated and avoid the occurrence of APO to a certain extent.For patients with SLE activity during pregnancy,prednisone,hydroxychloroquine and tacrolimus are safe drugs to use.