| Objective:To analyze the outcomes of pregnancies in women with systemic lupus erythematosus(SLE)and the risk factors affecting the adverse pregnancy outcomes.Methods:The data of SLE patients with pregnancy admitted from October,2005 and September,2015 in Nanfang Hospital were collected.We compared the maternal and fetal outcomes and complications between remittent and mild disease and moderate-to-severe disease activity.Their risk factors affecting the adverse pregnancy outcomes of the pregnancies were also analyzed.Statistical analyses were performed using the Statistical Package for the Social Sciences(SPSS)for Windows(Version 19.0).In all tests,the probability values were two-sided,and p values<0.05 were considered significant.Results:The 69 pregnancies in 66 SLE patients were included in this study.They had a mean age at SLE diagnosis of 22.9 ± 5.1 years with a mean duration of SLE of 4.1 ±3.6 years before pregnancy.The highest SLEDAI score was 6.8±7.4 during pregnancy.Forty-five(65.2%)of the patients received oral medication for SLE treatment during pregnancy,and 44(63.8%)were treated with prednisone and 19(27.5%)were treated with hydroxychloroquine.Except for 2 cases of non-family planning and 1 case of maternal condyloma acuminatum,24 cases(34.8%)of fetal loss occurred during the pregnancy,including 18(26.1%)therapeutic abortion,3(4.3%)stillbirth,2(2.9%)spontaneous abortion and 1(1.4%)maternal-fetal mortality.Forty-two(60.9%)pregnancies resulted in live birth and the mean birth weight of these 42 babies was 2640.5±672.0g,all but fifteen(21.7%)had a birth weight>2500g.Fifteen(21.7%)and 6(8.7%)cases were preterm delivery and IUGR,respectively.Patients with moderate-to-severe disease activity had a higher rate of fetal loss(12[54.5%]vs 12[25.5%])with a significantly lower full term birth(4[18.2%]vs 23[48.9%])and birth weight of the newborns(2073.0±778.7 vs 2817.8±533.7 g,P<0.05)than those with remittent or mild disease.There were 15 cases(21.7%)of new-onset SLE.Fifteen pregnancies(21.7%)were complicated by hypertension,and 7(10.1%)were preeclampsia/eclampsia.Seven cases(10.1%)developed gestational diabetes,and 7(10.1%)had an episode of pneumonia.Twenty-six(37.7%)active lupus nephritis and 10(14.5%)renal insufficiency occurred during pregnancy.HELLP syndrome developed in one women(1.4%),and one(1.4%)died in this study.The patients with moderate-to-severe disease activity also had higher rates of new-onset SLE(9[40.9%]vs 6[12.8%]),hypertension(12[54.5%]vs 3[6.4%]),active lupus nephritis(22[100%]vs 4[8.5%]),pneumonia(5[22.7%]vs 2[4.3%]),and renal insufficiency(8[36.4%]vs 2[4.3%])compared with patients with remittent and mild disease(P<0.05).To analyze the risk factors affecting the adverse pregnancy outcomes,we performed univariate and multivariate logistic regression analysis.Hypertension(OR=13.00,95%CI:1.60?105.93),active lupus nephritis(OR=9.68,95%CI:2.52?37.18),thrombocytopenia(OR=4.00,95%CI:1.02?15.60)were identified as the risk factors for the adverse pregnancy outcomes.Multivariate regression analysis showed that active lupus nephritis(OR=6.10,95%CI:1.43-25.96)was a significant predictor of adverse outcomes of the pregnancies.In new-onset SLE pregnancies,all of them occurred during the first and second trimester.The most common clinical features of new-onset SLE were renal and hematologic.Patients with new-onset SLE were more prone to fetal loss(11[73.3%]vs 13[24.1%]),hypertension(8[53.3%]vs 7[13.0%])and active lupus nephritis(9[60.0%]vs 17[31.5%]),as well as more renal insufficiency(5[33.3%]vs 5[9.3%]).Conclusion:Fetal loss and maternal complications are common in patients with SLE in relation with the disease activity.Active lupus nephritis is a predictor for poor outcomes of pregnancies in SLE patients.Patients with new-onset SLE during pregnancy had poorer pregnancy outcomes.Pregnancies in SLE patients must be closely watched and treated during all trimesters to improve pregnancy outcomes. |
PDF Full Text Request