Value Of Elective Pregnant Timing To Improve Gestational Outcome For Women With Systemic Lupus Erythematosus

Objective To provide the best timing of pregnancy for women with systemic lupuserythematosus (SLE) and improve the perinatal quality, factors related to the pregnantoutcome were analyzed. Placenta pathology and cytokine measuring were performedto research the immunologic mechanism of complement activation effectingantiphospholipid antibody associated maternal-fetus’ sequence.Methods46cases of pregnant women complicated with SLE accepted in FujianProvincal Hospital from2003January to2013January were chose to analyzeretrospectively, and were divided into two groups by different phases of SLE tocompare their clinical outcome and complications,50cases of normal pregnantwomen were collect to contrast with pregnant with SLE. Placenta pathology andimmunohistochemistry of C1q and C4d were compared for16placentas of pregnantwomen with SLE and20placentas of normal pregnant women (control group)accepted in Fujian Provincal Hospital from2011January to2013January.Results The clinical features of SLE activity in pregnant women were erythema andcanker sore. The SLE activity rate, premature delivery rate and FGR rate innon-guidance-pregnancy group were higher than those in guidance-pregnancy groupstatistically (p<0.05). The gestational weeks and the weight of neonates innon-guidance-pregnancy group were smaller than them in guidance-pregnancy groupstatistically (p<0.05). Complications such as infection, cardiac dysfunction andmultiple organ dysfunction were more in non-guidance-pregnancy group thanguidance-group. Though the gestational weeks and the weight of neonates inguidance-pregnancy group were smaller than them in normal group, there was nodifference in premature delivery rate and FGR rate between these two groups. Theextent of the disease effected the outcome, preterm delivery rate and FGR rate werehigher in severe group than mild and modest groups, gestational week and neonatalweight was lower than those. It was dictated that pregnancy in remission and controlled term can improve gestational outcome.16placentas of pregnant womenwith SLE were found degeneration of villus, partly infartion, thrombopoiesis, partlycalcification and acute or chronic inflammatory cell infiltration. C4d diffuse dyeingwas found in maternal-fetal junction of9SLE pregnancies with7non-guidance-pregnancy (77.8%),2guidance-pregnancy (22.2%),5FGR (55.6%) and6preterm delivery (66.7%); C4d focal dyeing was found in7pregnancies, which werehigher than control group. There was not statistical difference about placentasimmunohistochemistry of C1q dyeing between two group.Conclusions The outcome of guidance-group was improved in pregnant womenwith SLE, with less pregnant complication; severe C4d diffuse dyeing inmaternal-fetal junction of SLE pregnancies was associated with poor neonataloutcome, for non-guidance-pregnancy specially, C4d counld be seem as a biomarkerfor antiphospholipid antibody associated maternal-fetus’ sequence and as evidence toimprove outcome of secondary pregnancy. In order to get a successful pregnancyoutcome SLE women could get pregnancy at the controlled and remission stages ofSLE. Activity of SLE is the main factor leading to pregnancy loss. Strengthening theperinatal care during pregnancy is very important to reduce pregnancy complications.