Pregnancy In Systemic Lupus Erythematosus:a Retrospective Study Of41Cases

ObjectiveTo explore the clinical characteristics and pregnancy outcomes of pregnancies complicated with systemic lupus erythematosus(SLE),and try to evaluate the factors correlated with the maternal and fetal outcomes.Materials and MethodsThe study was designed to investigate clinic data in pregnant SLE patients retrospectively from Qilu Hospital of Shandong University between Aug2005and Sept2011.Assessments of the disease activity and degree were conferred to Systemic Lupus Eryfhematosus Disease Activity Index(SLEDAI),with a flare defined as a score of≥5points.Results41pregnant SLE patients were observed, with10first diagnosed during pregnancy.Twenty-six out of41pregnancies of SLE mothers(63%) were characterized by disease flare according to the maximum SLEDAI score during pregnancy. In flare group,four (15%) flared in the first trimester of gestation, while10(39%) and12(46%) in the second and third trimester,respectively. Of these,17(65%) were mild on desease degree. Proteinuria、 erythra and elevated titer of dsDNA were observed in more than half mothers during SLE flare.The rates of therapeutic abortion、total pregnancy loss and Small for gestational age(SGA) were significantly higher in flare group than non-flare group(P<0.05for all). Also,a Statistical difference was found between the two groups on severe preeclampsia for third trimester patients (39%flare group vs7%no flare, P=0.046).While, no significant differences were found on other obstetrical complications,including gestational hypertension premature rupture of membranes (PROM)、oligohydramnios、 fetal distress and postpartum hemorrhage (P＞0.05).28(68%) resulted in a live birth,with15in non-flare group and13flare group.The delivery time ranged from29.86to39.43weeks,12cases as preterm and16cases as term delivery,respectively. Yet no significant differences were found between the two groups on delivery modes (P＞0.05).13(32%) ended with pregnancy loss.Compared with patients in clinical remission and control period pre-conception,there was a higher rate of pregnancy loss for those in flare and first diagnosed patients (P＜0.05)Additionally, in flare group,one pregnant woman died,3suffered flare in the postpartum and one live born infant had neonatal lupus syndromes(NLS).For SLE flare pregnancies complicated with lupus nephritis(LN),the occurrence of severe preeclampsia was more frequently than these without LN(100:14, P=0.003). Compared with patients on regular inspection,there were a decrease proportion in live birth, increased proportions in fetal loss and SGA in patients without regular inspection,although these did not reach statistical differences (P＞0.05). No statistical difference was reached on fetal loss for prior SLE patients with either a pregnancy or pregnancy loss history (P＞0.05)ConclusionSLE flare can occur any time during pregnancy, including postpartum period.Fortunately,most are mild on disease degree.Patients in flare pre-conception are more likely to experience disease flares during pregnancy.Disease flare leads to increased risks of poor fetal and maternal outcomes,and may cause life-threatening manifestations. While, the majority patients can achieve nice pregnancy outcomes.In addition to disease flare,flare at conception、 SLE onset in pregnancy and LN activity can also increase the risk of poor pregnancy outcomes. Thus, it is essential to have a careful preconception planning, choose a appropriate time for conception and monitor carefully during pregnancy.Only through these can we improve pregnancy outcomes in SLE patients.