Influence Of Disease Control On Disease Activity And Pregnancy Outcome Of Pregnant Women Complicated With Systemic Lupus Erythematosus

ObjectiveIn this study,We analyzed the clinical manifestations and laboratory data from118 cases of pregnant women complicated with systemic lupus erythematosus(systemic lupus erythematosus,SLE),in order to learn that whether the difference of disease control in patients with SLE could lead to different changes in condition during pregnancy and different outcomes of pregnancies,and discuss risk factors during pregnancy of disease progression of SLE and adverse pregnancy outcomes.On this basis,we could find the right time to conceive for patients with SLE and provide appropriate care during pregnancy,thereby increasing the rate of successful pregnancy in patients with SLE.MethodsData were collected from a total of 118 pregnant women complicated with systemic lupus erythematosus treated by Guangzhou First Municipal People's Hospital from June 2004 to October 2015 and a normal control group consist of 40 pregnant women without underlying diseases with consecutive outpatient number of obstetrics clinic in 2014.Patients with SLE were divided into selective pregnant group(who were in the inactive phase of disease and the using of glucocorticoid and Immunosuppressants met the requirements)and non-selective pregnant group(this group contained those patients with SLE who didn't met the requirements of selective pregnant group)by the condition of disease control to collect data including general condition?disease activity changes during pregnancy?treatment?pregnancy outcomes?autoantibodies and general laboratory tests,whie the normal control group collecting data including general condition and pregnancy outcomes.We Compared the changes in disease activity of the two groups to analyze whether there were differences in disease progression.and next we analyzed the influences on pregnancy outcomes of disease control and the difference of pregnancy risk among the three groups,and looked for risk factors of adverse pregnancy outcomes.Results 1?Comparison of patients' disease progression during pregnancy between two SLE groups(1)The increasing of system damages in two SLE groupsThe rates of increasing blood?kidney damages?erythra?arthritis and serositis in non-selective pregnant group were higher than those in selective pregnant group(P<0.05),In all patients with SLE,The most frequently affected systems were kidney(33cases,27.9%)?blood(26cases,22%)and erythra(17cases,14.4%).(2)Disease progression during pregnancy of two SLE groups and risk factors12 patients(16.7%)of selective pregnant group occurred disease progression while 28 patients(73.7%)of non-selective pregnant group having the same change,and the difference had statistical significance(P<0.05).Patients with SLE tended more to get disease progression in middle and late stage of pregnancy than in the early stage(P<0.05).The logistic regression model told that risk factors which causing disease progression during pregnancy were hypocomplementemia,24 hour urine protein quantity > 0.5g,SLEDAI score level before pregnancy and anti-ds DNA antibody positive.2?Comprison 0f pregnancy complications among non-selective pregnant group?selective pregnant group and normal control groupNon-selective pregnant group had a higher rate than selective pregnant group and normal control group in complications of pregnancy-induced hypertension ?preeclampsia?total infections(P<0.05).Between selective pregnant group and normal control group,only the rate of preeclampsia had significant difference(P<0.05).3?Fetal outcomes(1)Fetal lossThere were 19 cases of successful delivery(41.3%)in the non-selective pregnant group,while the numbers in selective pregnant group and normal control group were 68(94.4%)and 39(97.5%)respectively.Non-selective pregnant group had a higher rate than selective pregnant group and normal control group in therapeuticinduced labor?stillbirth and total fetal loss(P<0.05).There was no significant difference in various ways of fetal loss between selective pregnant group and normal control group.The logistic regression model told that risk factors of fetal loss included 24 hour urine protein quantity > 0.5g,SLEDAI score level before pregnancy,renal dysfunction during pregnancy and anticardiolipin antibody positive((P<0.05).(2)Delivery mode and general condition of fetusNon-selective pregnant group had a higher rate than selective pregnant group and normal control group in premature birth and low birth weight(P<0.05).There was significant difference between non-selective pregnant group and normal control group in the rate of natural labour(P<0.05),while no difference was found between non-selective pregnant group and selective pregnant group in the same aspect(P>0.05).Between selective pregnant group and normal control group,the rates of natural labour?premature birth and low birth weight had significant difference(P<0.05).(3)Complication of newborns and neonatal lupusNon-selective pregnant group had a higher rate than selective pregnant group and normal control group in neonatal jaundice and mild asphyxia(P<0.05).,while no difference was found between selective pregnant group and normal control group in complications of newborns.(P>0.05).There was no statistical difference in the rate of neonatal lupus between two SLE groups(P>0.05).Conclusion1?During pregnancy the most frequently affected system were kidney?blood and erythra in patients with SLE.The disease condition of non-selective pregnant group were prone to get worse more easily than selective pregnant group.Patients with SLE tended more to get disease progression in middle and late stage of pregnancy than in the early stage.Risk factors which causing disease progression during pregnancy were hypocomplementemia,24 hour urine protein quantity > 0.5g,SLEDAI score level before pregnancy and anti-dsDNA antibody positive.2?Non-selective pregnant group produced more fetal losses and complications than selective pregnant group and normal control group,and There was no significant difference between the latter two groups in aspects mentioned above.Risk factors of fetal loss included 24 hour urine protein quantity > 0.5g ? SLEDAI score level before pregnancy,renal dysfunction during pregnancy and anticardiolipin antibody positive.3?Patients with SLE should conceive under good condition of disease,and intense pregnant monitoring in order to make a successful pregnancy.