Adverse Pregnancy Outcomes In Women With Systemic Lupus Erythematosus

BackgroundSystemic lupus erythematosus (SLE) is a multisystemic autoimmune connective tissue disease that occurs predominantly in women of fertile age. Due to medical advances the number of SLE patients who become pregnant has increased worldwide, and rates of fetal loss have declined substantially from 43% in the 1960s to 17% in the early 2000s, but continue to be higher than the general population. Patients with SLE had a 2-4-fold higher risk of pregnancy-related complications as compared to non-SLE patients:spontaneous abortion, intrauterine fetal death, preterm birth, preeclampsia, intrauterine growth restriction, neonatal lupus and neonatal death.ObjectivesTo summarize the maternal and fetal outcomes of pregnancies of patients with systemic lupus erythematosus (SLE) and to evaluate the clinical predictors of adverse pregnancy outcomes.MethodsSixty one pregnancies in 55 SLE patients treated between January 2000 and December 2015 in Women’s Hospital School of Medicine Zhejiang University were investigated retrospectively.ResultsFifty five cases of SLE patients had 61 pregnancies in total. After exclusion of artificial abortions and ectopic pregnancies, there were 36 cases of successful delivery (73.5%). Adverse pregnancy outcomes occurred in 30 pregnancies,7 cases of pre-eclampsia (14.3%),10 cases of spontaneous abortions (16.4%),3 cases of stillbirth (4.9%),6 cases of intrauterine growth restriction (IUGR) (9.8%),14 cases of prematurity,1 case of neonatal lupus,5 cases of neonatal death. SLE flares occurred in 15 pregnancies. The frequency of pre-eclampsia, IUGR and preterm birth in patients whose SLE was active during pregnancy was significantly higher than those whose lupus was stable (P> 0.05), but the rate of live birth was much lower (P< 0.05). The predictors of pre-eclampsia included lupus nephritis, active SLE during pregnancy (P< 0.05). The predictors of poor fetal outcome (including prematurity or IUGR) included lupus nephritis, active SLE during pregnancy,≥20 mg/d dosage of prednisone during pregnancy. No association was found between thrombocytopenia or leukopenia or fever or rash and adverse pregnancy outcomes (P> 0.05). Compared with normal pregnancies, renal pregnancies were younger at SLE disease onset.ConclusionsThe combined lupus nephritis and SLE flares during pregnancy increases the risk of adverse pregnancy outcomes, and≥20 mg/d dosage of prednisone during pregnancy increases the risk of prematurity.