Retrospective Clinical Analysis Of New-onset Systemic Lupus Erythematosus During Pregnancy

ObjectiveIn this study,we analyzed the clinical characteristics and laboratory data from 82 cases of new-onset systemic lupus erythematosus(SLE)during pregnancy,to summarize clinical characteristics and rate of adverse pregnancy outcomes of newonset SLE and to evaluate the factors affect to fetal loss.MethodsThe information of new-onset SLE patients with pregnancy admitted from January,2008 and December,2018 in Third Affiliated Hospital of Guangzhou Medical University were collected.The clinical manifestation,laboratory examination,SLEDAI,pregnancy outcome and treatment during pregnancy were summarized,.The clinical manifestation,laboratory examination,SLEDAI and treatments were compared according to different pregnancy outcomes.Adverse pregnancy outcomes were compared according to different treatments and SLEDAI.Result1.Of all the 82 new-onset SLE,6,40,35 and1 cases were diagnosed during first trimester,second trimester,third trimester and puerperium,respectively.All patients are in an active disease,14,32 and 32,cases with mild,moderate and severe SLE,respectively.The main clinical manifestations of new-onset SLE were lupus nephritis(87.8%),serositis(68.3%)and thrombocytopenia(58.5%).Of the 82 cases,46(56.1%)survived,of which 16(19.5%)were term births and 30(36.6%)were premature.Adverse pregnancy outcomes occurred in 36 cases(43.9%),of which 27 cases(32.9%)were therapeutic abortion or induced labor,2 cases(2.44%)neonatal death,4 cases(4.88%)fetal death in utero,and 3 cases(3.66%)spontaneous abortion.2.Compared with patients without adverse pregnancy outcomes,prevalence of leukopenia[9(25.0%)vs1(2.17%)] and digestive system damage[7(19.4%)vs2(4.35%)] was higher than patients with adverse pregnancy outcomes.The diagnosis time of adverse pregnancy outcomes group [(21.0 ±5.9weeks)vs(20.3 ±6.0weeks)] was earlier than that of no adverse pregnancy outcomes group(p < 0.05).The utilization rate of low molecular weight heparin [1(2.78%)vs9(19.6%)] and cyclosporine[1(2.78%)vs10(21.7%)] was lower than that of no adverse pregnancy outcomes group.3.According to SLEDAI,they were divided into mild group and moderate-severe group.The incidence of preeclampsia in moderate-severe group [19(27.9%)vs0(0.00)](p < 0.05)was higher than mild group.The rate of full term birth in the mild group [8(57.1)vs8(11.8)](p<0.05)] was higher than moderate-severe group.4.The rate of preeclampsia rate [14(42.4%)vs5(10.2%)] in the untreated group were higher than those in the treated group group(p < 0.05).Conclusion:New-onset SLE mainly occurred during the second and third pregnancy trimesters.The outcome of pregnancy in the new-onset SLE was poor.leukopenia and digestive system damage increased the occurrence of adverse pregnancy outcomes.Late onset,Utilize heparin and/or cyclosporine before termination of pregnancy may increase fetal survival.Adverse pregnancy outcomes of new-onset need to be improved.If kidney,serous cavity and blood system are impaired or affected during pregnancy,SLE-related tests should be performed as soon as possible.Prompt diagnosis and treatment effectively improve adverse pregnancy outcome.