Low incidence of intrauterine growth restriction in pregnant patients with systemic lupus erythematosus taking hydroxychloroquine

Background Systemic Lupus Erythematosus (SLE) has a tendency to occur in women in their reproductive years, causing complications during pregnancy and labour. Conversely, pregnancy can cause flares of disease activity, often necessitating immediate intervention. Aim of study to study pregnancy related complications in patients with SLE. Patients and methods The study included 48 SLE pregnant females. 27 patients with 38 pregnancies, their data viewed retrospectively from medical records, and 21 patients with 21 pregnancies followed up prospectively. The laboratory data included ANA, DNA, APL antibodies and anti Ro/SSA. The disease activity was calculated according to the Systemic Lupus Activity Measure. Ultrasound was performed to confirm gestational age and assess for the presence of any congenital fetal malformations, and then repeated monthly to detect any abnormality including intrauterine growth restriction. At 30 weeks gestation and onwards, assessment of fetal wellbeing including daily fetal kick chart and once weekly non stress test was performed. Doppler blood flow velocimetry was done for those with abnormal fetal heart rate pattern. After labour, the neonate was examined for complications including complete heart block and neonatal lupus. Results Anti dsDNA was found in 95% of the patients, anti Ro/SSA in 6% and anti APL in 30%. 57% of the patients followed up prospectively had active disease in the 1st trimester, 24% in the 2nd and 62% in the 3rd trimester. The most common maternal complication was preeclampsia 33%, followed by spontaneous abortion 20%. Prematurity was the most common fetal complication 37%, followed by intrauterine growth restriction 29%. 2 neonates were born with congenital heart block and 1 with neonatal lupus. Conclusion Pregnancy in SLE patients is associated with a higher risk of obstetric complications affecting both the mother and the fetus. Preeclampsia was the most common complication followed by prematurity. Preeclampsia was significantly associated with third trimester disease activity.

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Systemic sclerosis and pregnancy outcomes: a retrospective study from a single centre

10.21203/rs.3.rs-876464/v1 ◽

2021 ◽

Author(s):

Giuseppe Barilaro ◽

Aleida Castellanos ◽

Inês Gomes Ferreira ◽

Gema Maria Lledó ◽

Carlo Della Rocca ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Retrospective Study ◽

Systemic Sclerosis ◽

High Risk ◽

Antiphospholipid Syndrome ◽

Lupus Erythematosus ◽

Pregnancy Outcomes ◽

Intrauterine Growth Restriction ◽

Systemic Lupus ◽

Intrauterine Growth

Abstract Background Pregnancy in systemic sclerosis (SSc) patients is no more an infrequent event as it used to be, but literature data on pregnancy outcomes in women with SSc are scarce. The rate of preterm deliveries and intrauterine growth restriction (IUGR) seems to be increased, while the risk of miscarriages is controversial. Moreover, no study compared pregnancy outcomes in SSc with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). We performed a retrospective study to compare the pregnancy and disease outcomes of women with SSc with a cohort of age-matched women with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS) and healthy controls (HC). Methods 154 pregnancies from SSc, SLE, APS patients and HC were prospectively followed at the High-Risk Pregnancy Unit of our center from 2008 to 2019. The primary outcome was a composite endpoint of miscarriages, fetal deaths, intrauterine growth restriction (IUGR), preeclampsia, neonatal deaths, preterm birth, and small-for-gestational-age (SGA) newborns. Single APO represented secondary endpoints. SSc activity variations in relation to pregnancy were assessed. Results The risk of APO was significantly higher in SSc patients compared to HC (60.6% vs 10.0%; OR = 14.42; 95% CI 3.70–56.18, p = 0.001) and SLE patients (60.6% vs 37.5%; OR = 3.56; 95% CI 1.29–9.83, p = 0.014). Compared to HC, women with SSc had an increased frequency of first trimester miscarriage (15% vs 0 %; p = 0.016), preeclampsia (12% vs 0%, p = 0.038), IUGR (15% vs 0%; p = 0.016), and SGA newborns (21.2% vs 0%; p = 0.003). Preterm deliveries were more frequent in SSc pregnancies in comparison to HC (24.2% vs 5%; OR = 6.08; 95% CI 1.19–31.02, p = 0.036) and SLE patients (24.2% vs 7.5%, OR = 5.68; 95% CI 1.1–29.38, p = 0.038). Disease remained stable in all SSc patients during pregnancy and up to one year after delivery. Conclusions We found an increased risk of APO in our SSc cohort in comparison to HC (with higher rates of miscarriages, preeclampsia, IUGR, SGA newborns and preterm deliveries) and SLE patients (presenting higher rate of preterm deliveries). High-risk multidisciplinary management of SSc pregnant women is highly recommended.

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Antiphosphatidylserine/prothrombin Antibodies in Antiphospholipid Syndrome with Intrauterine Growth Restriction and Preeclampsia

The Journal of Rheumatology ◽

10.3899/jrheum.170751 ◽

2018 ◽

Vol 45 (9) ◽

pp. 1263-1272 ◽

Cited By ~ 10

Author(s):

Valentina Canti ◽

Stefania Del Rosso ◽

Marta Tonello ◽

Roberta Lucianò ◽

Ariela Hoxha ◽

...

Keyword(s):

Antiphospholipid Syndrome ◽

Lupus Erythematosus ◽

Pregnancy Complications ◽

Intrauterine Growth Restriction ◽

Late Pregnancy ◽

Additional Treatment ◽

Growth Restriction ◽

Intrauterine Fetal Death ◽

Thrombotic Risk ◽

Intrauterine Growth

Objective.Antibodies that recognize the phosphatidylserine/prothrombin complex (antiphosphatidylserine/prothrombin antibodies; aPS/PT) might reveal enhanced thrombotic risk in patients with systemic lupus erythematosus. Little is known about their association with pregnancy complications in the antiphospholipid syndrome (APS).Methods.We enrolled 55 patients with APS who were seeking pregnancy in 2 Italian hospitals. Antiphospholipid antibodies (aPL), including anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, lupus-like anticoagulant, and aPS/PT antibodies were assessed, and the patients were prospectively followed for 24 months.Results.There were 65% (36/55) of the APS patients who had aPS/PT antibodies. Forty-seven pregnancies were followed, including 33 of aPS/PT+ patients. Forty-one of the 47 patients (87%) who initiated a pregnancy eventually gave birth to a child. The pregnancy duration and the mean newborn weight at delivery were significantly lower in aPS/PT+ than in aPS/PT− patients (33.1 ± 4.7 vs 36.2 ± 3.4 wks of gestation, respectively, and 2058 ± 964 g vs 2784 ± 746 g, respectively, p < 0.05). Late pregnancy complications, including intrauterine fetal death, preterm delivery, preeclampsia, and intrauterine growth restriction (IUGR), were more frequent in aPS/PT+ patients, independent of the therapy. Titers of aPS/PT IgG were significantly inversely correlated with the neonatal weight at delivery. Vascular injury, as reflected by thrombosis, fibrinoid necrosis, ischemic and hemorrhagic areas, and presence of chorangiomas characterized the IUGR placentas in the presence of aPS/PT.Conclusion.The aPS/PT antibodies might represent markers of aPL-related pregnancy complications, IUGR/preeclampsia in particular, and could help identify beforehand patients who may require additional treatment.

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The possible role of interleukin-16 in the low incidence of HIV infection in patients with systemic lupus erythematosus

Lupus ◽

10.1191/096120300678828136 ◽

2000 ◽

Vol 9 (2) ◽

pp. 155-156 ◽

Cited By ~ 12

Author(s):

I Sekigawa ◽

S Lee ◽

H Kaneko ◽

N Iida ◽

H Hashimoto ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Hiv Infection ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Low Incidence

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Subdural Hematoma Presenting as Headache in Systemic Lupus Erythematosus

Cephalalgia ◽

10.1046/j.1468-2982.1990.1001025.x ◽

1990 ◽

Vol 10 (1) ◽

pp. 25-29 ◽

Cited By ~ 6

Author(s):

Gunnar Bovim ◽

Størker Jørstad ◽

Harald Schrader

Keyword(s):

Systemic Lupus Erythematosus ◽

Nervous System ◽

Lupus Erythematosus ◽

Neuropsychiatric Symptoms ◽

Severe Headache ◽

Neurological Manifestations ◽

Systemic Lupus ◽

Subdural Hematomas ◽

Psychiatric Disturbances ◽

Low Incidence

Systemic lupus erythematosus (SLE) affects the nervous system in 75% of cases (1). A female with several neurological manifestations in the case history presented with severe headache, psychiatric disturbances, and increasing paraparesis. She was found to have bilateral subdural hematomas, and after evacuation her neuropsychiatric symptoms, including headache, disappeared. It is speculated that the reported low incidence of subdural hematomas in SLE may be more apparent than real. On the basis of our case, we recommend repeated neuroradiological investigations to uncover this important, treatable and otherwise potentially fatal cause of headache.

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