A Clinical Research Of 135 Cases Patients With Systemic Lupus Erythematosus During Pregnancy

Objective:To summarize the pregnancy outcomes of systemic lupus erythematosus patiences, as well as the disease activity, and to analyze the influencing factors of adverse pregnancy outcomes of SLE patients, in order to provide some references for the clinical diagnosis and treatment of the disease.Methods:We retrospective analyzed the clinical material of 135 cases patients with systemic lupus erythematosus during pregnancy, who hospitalized in the first affiliated hospital of Guangxi medical university hospital during January 2007 to October 2014. According to the pregnancy time,135 cases patients with SLE were divided into two groups:the group of planned pregnancies and the group of nonselective pregnancies. The 83 patients, who belong to planned pregnancies group, were divided into two subgroups according to the SLE disease activity:group A (the SLE deterioration) and group B (the SLE in stable condition). The duration, system involvement, and general laboratory test results, the illness deterioration, maternal and infant complications, fetal loss, as well as the treatment and outcome of the disease were recorded. The comparion between the group of planned pregnancies and the group of nonselective pregnancies were done. Quantitative variable including disease onset age, disease activity, SLEDAI score were recorded as mean±SD. Dichotomous variable, such as the stage of pregnancy, pregnancy outcome, and so on, were showed as percentage. Independent t test was performed to compare the means of continuous variable. Mann-Whitney U test was used when normal distribution or equal variance could not be assumed. Chi-square test was performed to compare categorical variables. The Logistic regression analysis was used to analyze the risk factors of outcomes and complications. P value of<0.05(two sides) was considered significance.Results:1.122 cases of SLE patients had 135 pregnancies in total. In 83 cases (61.5%) of planned pregnancies, SLE deterioration occurred in 30 pregnancies (36.1%). In 52 cases of unplanned pregnancies,43 cases had new-onset SLE during pregnancy; 48 cases(92.3%) had deteriorated during pregnancy. The deterioration rate of unplanned pregnancies was obviously higher^han that of planned pregnancies (P<0.01). SLE deterioration during pregnancy has closely connection with the urine protein positive, white blood cells reduce and SLEDAI scores (P<0.05). In 83 cases of planned pregnancies, the preeclampsia occurred in 11 cases (13.3%), the premature rupture of membranes occurred in 16 cases (19.3%), and gestational diabetes occurred in 4 cases (4.8%). In 52 cases of nonselective pregnancies, the preeclampsia occurred in 3 patients (5.8%),4 cases were premature rupture of membranes (7.7%),4 cases died (7.7%). The difference of two groups patients with preeclampsia had no statistical significance (P>0.05).2. The planned pregnancy group (83 cases) were successful delivery of 62 cases (74.7%). Among them, there are 50 cases of full-term pregnancy (60.2%), 12 cases (14.5%) with premature,17 cases (20.5%) with therapeutic abortion, stillbirth occurred in 4 cases (4.8%),19 cases (22.9%) with fetal growth restricted, fetal malformation occurred in 4 cases (4.8%).52 cases of the nonselective pregnancies successful delivery of 10 cases (19.2%), and there are 6 cases of full-term pregnancy (11.5%),4 cases (7.7%) with premature, spontaneous abortion occurred in 1 case (1.9%),38 cases (73.1%) with therapeutic abortion, stillbirth occurred in 5 cases (9.6%), neonatal in fetal growth restriction occurred in 8 cases (15.4%) and fetal deformity occurred in 1 case (1.9%). The patients of the nonselective pregnancy have a greater risk of FGR, stillbirth or patients died.3. The risk factors which causing the FGR were C3 on the low side and Anti-Siogren-A Antibody positive (P<0.05). The risk factors of fetal preterm birth were the urine protein quantitation, which is greater than 0.5g/24h (P<0.05). By Logistic regression analysis found that low complement, the reduce of white blood cell count and platelet count, as well as anemia, are independent risk factors for the development of fetal loss (P< 0.05).Conclusion:1. The planned pregnancy patients with systemic lupus erythemato-sus have lower risk of relapse.2. The planned pregnancy can improve fetal live-birth rate and reduce the risk of fetal loss.3. The risk factors of adverse pregnancy outcomes are low complement continuously, leukopenia, thrombocytopenia and anemia.