Pregnancy Outcomes in A Group Egyptian Patients with Systemic Lupus Erythematosus: A Cohort Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
DF Mohammed ◽  
HE Mansour ◽  
AE El-Feky ◽  
SM Hosny ◽  
CS Morad ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Fetal Loss ◽  
University Hospital ◽  
Intrauterine Fetal Death ◽  
Control Group ◽  
Childbearing Age ◽  
Systemic Lupus

Abstract Background Systemic lupus erythematosus (SLE) predominantly affects women of childbearing age thus pregnancy in lupus patients is a common clinical scenario. SLE adversely affects pregnancy outcomes and pregnancy leads to SLE flares Aim of the work Determining the frequencies and predictors of maternal and fetal pregnancy outcomes in women with SLE by a prospective cohort study Patients and methods seventy-one pregnant lupus patients were followed prospectively, and their data compared to age-matched pregnant healthy controls attending Ain Shams University Hospital clinics Results Thirteen Patients had activity at conception. Sixty-six(93%) Where on treatment. Flares occurred in 51 patients (72%) during pregnancy with nephritis being the most common occurring in 78%. The prevalence of anemia, AKI and hypertension (HTN) during pregnancy were higher in SLE group than control group (P < 0.01). The rate of delivery by Cesarean section (CS), PTL, postpartum hemorrhage, preeclampsia (PE), severe PE and HELLP were higher in SLE group then control group (P < 0.01) as well as an increase in rate of postpartum infection (P < 0.05). There was an increase in rate of fetal loss, prematurity, intrauterine growth restriction (IUGR), NICU admission, still birth/intrauterine fetal death and highly significant decrease in fetal weight in SLE group than control group (P < 0.01). Pregestational HTN was independently associated with PE (OR 91.228; CI 6.791-1225.538). Proteinuria and HTN during pregnancy were independently associated with prematurity (OR 14.162 CI 1.029-194.958 & OR 10.596, CI 1.460-76.894). Conclusion Pregnancy in lupus patients carries a higher risk of pregnancy morbidity and worse fetal outcomes than the controls.

scholarly journals Understanding and Managing Pregnancy in Patients with Lupus

2015 ◽  
Vol 2015 ◽  
pp. 1-18 ◽  
Author(s):  
Guilherme Ramires de Jesus ◽  
Claudia Mendoza-Pinto ◽  
Nilson Ramires de Jesus ◽  
Flávia Cunha dos Santos ◽  
Evandro Mendes Klumb ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Fetal Loss ◽  
Systemic Lupus ◽  
Close Collaboration ◽  
Risk Condition ◽  
Pregnancy And Delivery ◽  
Maternal Disease ◽  
Active Disease

Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that occurs predominantly in women of fertile age. The association of SLE and pregnancy, mainly with active disease and especially with nephritis, has poorer pregnancy outcomes, with increased frequency of preeclampsia, fetal loss, prematurity, growth restriction, and newborns small for gestational age. Therefore, SLE pregnancies are considered high risk condition, should be monitored frequently during pregnancy and delivery should occur in a controlled setting. Pregnancy induces dramatic immune and neuroendocrine changes in the maternal body in order to protect the fetus from immunologic attack and these modifications can be affected by SLE. The risk of flares depends on the level of maternal disease activity in the 6–12 months before conception and is higher in women with repeated flares before conception, in those who discontinue useful medications and in women with active glomerulonephritis at conception. It is a challenge to differentiate lupus nephritis from preeclampsia and, in this context, the angiogenic and antiangiogenic cytokines are promising. Prenatal care of pregnant patients with SLE requires close collaboration between rheumatologist and obstetrician. Planning pregnancy is essential to increase the probability of successful pregnancies.

scholarly journals Pregnancy outcomes in patients with rheumatoid arthritis and systemic lupus erythematosus. Part I. Maternal outcomes

2019 ◽  
Vol 57 (2) ◽  
pp. 180-185 ◽  
Author(s):  
N. M. Kosheleva ◽  
E. V. Matyanova ◽  
E. V. Fedorova ◽  
N. I. Klimenchenko
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Control Group ◽  
Maternal Outcomes ◽  
Third Trimester ◽  
Systemic Lupus ◽  
Arterial Perfusion

Improved diagnosis and treatment of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) contribute to the remission of the disease and improve the quality of life of patients. In this regard, more and more women with RA and SLE decide to have pregnancy, which makes it actual to study the features of its course and outcomes in these diseases.Objective: to evaluate maternal pregnancy outcomes in patients with RA and SLE.Subjects and methods. 76 cases of pregnancy were traced prospectively in 72 patients: 32 pregnancies in 29 patients with RA and 44 pregnancies in 43 patients with SLE.Results and discussion. 72 of 76 (94.7%) supervised pregnancies ended in childbirth with the birth of a viable baby. There were three cases of pregnancy loss in the second trimester in SLE patients with concomitant antiphospholipid syndrome (AFS) and one case (3.1%) of perinatal infant death (a boy and a girl, monochorionic diamniotic twins with reverse arterial perfusion syndrome) in a patient with seropositive RA. Compared with the all-Russian population, the supervised RA and SLE patients more often had prematurely birth (37.5‰, 18.7% and 22.7%) and caesarean section (CS; in 236.7‰, 50%, and 56.8% respectively). In the SLE group CS was conducted due to the emergency reasons more frequently than in RA, (respectively 47,7% and 25%, relative risk of 1.9 [1; 3.7]; p=0.04). CS at the first birth was performed more often during RA and SLE than before the onset of the disease (p<0.001). Preeclampsia in patients with RA was diagnosed more often than in the population (9.4% and 15.7 per 1000 births, respectively). There was a reverse correlation between the timing of delivery and disease activity according DAS28-CRP in II (r= 0.5; p=0.01) and III (r= 0.6; p=0.0005) trimesters of pregnancy, and in patients with moderate and high activity of RA in the third trimester (n=12) delivery was earlier than in the control group (n=20), remission or low activity of RA (p<0.01). In patients with SLE who had birth prematurely (22.7%), the duration of the disease (p=0.02) and the duration of oral glucocorticoid therapy (p=0.003) were greater compared with SLE patients having term birth (70.5%); the dose of glucocorticoids at the time of conception and delivery did not affect the timing of delivery.Conclusion. Planning of pregnancy in patients with RA and SLE, monitoring during pregnancy and timely correction of therapy contribute to uncomplicated course of gestation and improve maternal outcomes.

Successful Pregnancy Outcome in a Case of Systemic Lupus Erythematosus

2017 ◽  
Vol 9 (2) ◽  
pp. 134-136
Author(s):  
Leelavathi Basava ◽  
K Triveni ◽  
G Sindhu Sree
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Pregnancy Outcome ◽  
Lupus Erythematosus ◽  
Immunosuppressive Agents ◽  
Fetal Loss ◽  
Therapeutic Interventions ◽  
Elective Cesarean Section ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
Successful Pregnancy

ABSTRACT Systemic lupus erythematosus (SLE) is an autoimmune disease most frequently found in women of childbearing age and may coexist with pregnancy. Disease exacerbation, increased fetal loss, neonatal lupus, and an increased incidence of preeclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids, and immunosuppressive agents pose a high risk for both the mother and the fetus during the antenatal period as well as postpartum. Good multidisciplinary medical care is mandatory when detection or flare-up of SLE occurs during pregnancy. We describe the successful management of an antinuclear antibody, antiribonucleoprotein antibody, and anti-Sjogren's syndrome A (Ro) antibody positive parturient with bad obstetric history who underwent elective cesarean section and delivered a healthy child. How to cite this article Basava L, Roy P, Triveni K, Sree GS. Successful Pregnancy Outcome in a Case of Systemic Lupus Erythematosus. J South Asian Feder Obst Gynae 2017;9(2): 128-130.

scholarly journals Incidence and risk factors of osteomyelitis in adult and pediatric systemic lupus erythematosus: a nationwide, population-based cohort study

Lupus ◽  
2018 ◽  
Vol 28 (1) ◽  
pp. 19-26
Author(s):  
Y.F. Huang ◽  
Y.S. Chang ◽  
W.S. Chen ◽  
Y.P. Tsao ◽  
W.H. Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Incidence Rate ◽  
Bone Fracture ◽  
Lupus Erythematosus ◽  
Cox Proportional Hazards ◽  
Control Group ◽  
Systemic Lupus ◽  
Increased Risk

Objective The objective of this paper is to investigate the incidence rate, risk factors and outcome of osteomyelitis among patients with systemic lupus erythematosus (SLE). Materials and methods We conducted a cohort study using data for patients enrolled in the Taiwan National Health Insurance Database from 2000 to 2012. Patients with SLE and age- and sex-matched controls without SLE were enrolled. Primary endpoint was the first occurrence of osteomyelitis. Risks of osteomyelitis in SLE patients were analyzed with Cox proportional hazards regression models, including age, sex, comorbidities and medications. Results Among 24,705 SLE patients (88.4% women, mean age 35.8 years) with a median follow-up of 9.1 years, 386 patients had osteomyelitis. The incidence rate ratio (IRR) of osteomyelitis in the SLE group vs the control group was 8.52 (95% confidence interval (CI) 7.24–10.05). The SLE group had higher incidence rates of osteomyelitis than the control group, especially in pediatric subgroups (IRR 41.1 95% CI 18.57–107.35). Compared to controls, SLE patients experienced osteomyelitis at a younger age (42.3 vs 58.1 years) but did not have an increased risk of mortality (hazard ratio 0.7; 95% CI 0.21–2.38). Age >60 years, male gender, malignancy within five years, prior bone fracture and higher daily prednisolone dose (>7.5 mg) cumulatively for >180 days increased risk for osteomyelitis. Conclusions SLE patients have a higher IRR of osteomyelitis than controls. Pediatric and elder SLE patients, patients with a history of bone fracture, malignancy within five years and higher-dose glucocorticoid use have a higher risk of osteomyelitis and should be carefully monitored.

scholarly journals Systemic Lupus Erythematosus Pregnancy

2021 ◽  
Author(s):  
Melissa Fernandes ◽  
Vera Bernardino ◽  
Anna Taulaigo ◽  
Jorge Fernandes ◽  
Ana Lladó ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Pharmacological Therapy ◽  
Adverse Pregnancy Outcomes ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
Fetal Outcomes ◽  
Adverse Pregnancy

Systemic Lupus Erythematosus (SLE) is an autoimmune disease of unknown etiology that often affects women during childbearing age. Pregnant women with SLE are considered high-risk patients, with pregnancy outcomes being complicated by high maternal and fetal mortality and morbidity. Obstetric morbidity includes preterm birth, fetal growth restriction (FGR), and neonatal lupus syndromes. Active SLE during conception is a strong predictor of adverse pregnancy outcomes and exacerbations of disease can occur more frequently during gestation. Therefore, management of maternal SLE should include preventive strategies to minimize disease activity and to reduce adverse pregnancy outcomes. Patients with active disease at time of conception have increased risk of flares, like lupus nephritis, imposing a careful differential diagnosis of pre-eclampsia, keeping in mind that physiological changes of pregnancy may mimic a lupus flare. Major complications arise when anti-phospholipid antibodies are present, like recurrent pregnancy loss, stillbirth, FGR, and thrombosis in the mother. A multidisciplinary approach is hence crucial and should be initiated to all women with SLE at childbearing age with an adequate preconception counseling with assessment of risk factors for adverse maternal and fetal outcomes with a tight pregnancy monitoring plan. Although treatment choices are limited during pregnancy, prophylactic anti-aggregation and anticoagulation agents have proven beneficial in reducing thrombotic events and pre-eclampsia related morbidity. Pharmacological therapy should be tailored, allowing better outcomes for both the mother and the baby. Immunosuppressive and immunomodulators, must be effective in controlling disease activity and safe during pregnancy. Hydroxychloroquine is the main therapy for SLE due to its anti-inflammatory and immunomodulatory effects recommended before and during pregnancy and other immunosuppressive drugs (e.g. azathioprine and calcineurin inhibitors) are used to control disease activity in order to improve obstetrical outcomes. Managing a maternal SLE is a challenging task, but an early approach with multidisciplinary team with close monitoring is essential and can improve maternal and fetal outcomes.

Preliminary study on the changes of ovarian reserve, menstruation, and lymphocyte subpopulation in systemic lupus erythematosus (SLE) patients of childbearing age

Lupus ◽  
2017 ◽  
Vol 27 (3) ◽  
pp. 445-453 ◽  
Author(s):  
H Gao ◽  
J Ma ◽  
X Wang ◽  
T Lv ◽  
J Liu ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
T Lymphocytes ◽  
Ovarian Reserve ◽  
Lupus Erythematosus ◽  
Lymphocyte Subpopulation ◽  
Control Group ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
High Incidence ◽  
Normal Menstruation

Objective The main aim of this study was to investigate the ovarian reserve, menstruation, and lymphocyte subpopulation in systemic lupus erythematosus (SLE) patients of childbearing age. Methods We enrolled 40 SLE patients of childbearing age and 40 age-matched healthy controls. Anti-Müllerian hormone (AMH) was tested by electrochemiluminescence, and lymphocyte subsets were tested by flow cytometry. Menstruation situation was obtained by interview. Results The AMH level of the SLE group was significantly lower than that of the control group ( p < 0.001), which was negatively correlated with erythrocyte sedimentation rate (ESR ( r = −0.316, p = 0.047)) and disease activity (SLEDAI ( r = −0.338, p = 0.033)). The AMH concentration of SLE patients with normal menstruation was higher than those with abnormal menstruation ( p < 0.001). The percentages of CD4+ T lymphocytes and NK (natural killer) cells in the SLE group were significantly lower than those in the control group ( p < 0.001). However, the percentages of B cells and CD8+ T lymphocytes in the SLE group were higher than those in the control group ( p < 0.05). Conclusion Decreased AMH and high incidence of abnormal menstruation indicated that autoimmunity activities of SLE can impair the ovarian reserve of female patients. Lymphocytes in SLE patients were in a state of disorder.

scholarly journals Pregnancy Outcomes in Systemic Lupus Erythematosus Women

2021 ◽  
Vol 21 (2) ◽  
pp. e244-252
Author(s):  
Nihal Al-Riyami ◽  
Bushra Salman ◽  
Amani Al-Rashdi ◽  
Tamima Al-Dughaishi ◽  
Rahma Al-Haddabi ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Preterm Birth ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Intrauterine Fetal Death ◽  
Systemic Lupus ◽  
Adverse Pregnancy ◽  
The Impact

Objectives: This study was conducted to assess pregnancy outcomes in women with systemic lupus erythematosus (SLE) in Oman. Methods: A retrospective cohort study of 149 pregnancies in 98 women with SLE was conducted over 10 years to evaluate the impact of clinical and laboratory parameters in predicting adverse pregnancy outcomes. Results: Mean maternal age was 30.6 ± 5 years ranging from 20–44 years, and the mean disease duration was 10 ± 5 years, ranging from 2–27 years. The most common maternal manifestations were joint pain in 36 (24.2%), lupus nephritis (LN) in 18 (12.08%), preeclampsia in 11 (7.4%), eclampsia in three (2%) and lupus flare in one pregnancy. The live birth rate was 139 (93.3%) with a mean gestational age of 36 ± 2 weeks ranging from 26–40 weeks. In total, 55 (39.6%) were preterm deliveries, six (4%) pregnancies ended in miscarriage, and four (2.7%) resulted in intrauterine fetal death. Intrauterine growth restriction was observed in 49 babies (35%). A significant association was found between hypertension (HTN) and miscarriage (P = 0.024) and preterm birth (P = 0.019). In addition, HTN was positively associated with preeclampsia (P = 0.004) and LN (P = 0.048). Antiphospholipid syndrome impacted preterm birth (P = 0.013) and postpartem haemorrhage (PPH) (P = 0.027) and was found to be a significant predictor for women developing deep vein thrombosis and pulmonary embolism (P <0.001 for both). Conclusion: Despite potential complications, most pregnancies complicated by SLE in Oman result in good outcomes. Adverse pregnancy outcomes, however, may still occur in women with SLE. In women with SLE, pregnancy planning, careful antenatal monitoring and efficient SLE treatment need to be undertaken for successful pregnancy outcomes. Keywords: Systemic Lupus Erythematosus; Pregnancy Outcomes; Lupus Nephritis; Antiphospholipid Antibodies; Neonatal Lupus.

Predictive factors of fetal and maternal pregnancy outcomes in Japanese patients with systemic lupus erythematosus

Lupus ◽  
2021 ◽  
pp. 096120332110319
Author(s):  
Kensuke Irino ◽  
Yojiro Arinobu ◽  
Masahiro Ayano ◽  
Shotaro Kawano ◽  
Yasutaka Kimoto ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Preterm Birth ◽  
Predictive Factor ◽  
Lupus Erythematosus ◽  
Fetal Loss ◽  
Japanese Patients ◽  
University Hospital ◽  
Systemic Lupus ◽  
Lupus Flare ◽  
The Impact

Objective The number of pregnant and delivery cases in systemic lupus erythematosus (SLE) patients are increasing due to the advances in therapies. However, there are many problems such as the exacerbation of SLE during pregnancy and the risk of fetal complications. We investigated the impact of both pregnancy on lupus and lupus on pregnancy in Japanese patients. Methods We retrospectively analyzed 64 pregnancies in 39 cases of lupus patients at Kyushu University Hospital, Japan, from October 2002 to July 2018 and then assessed the clinical profiles and maternal and fetal outcomes. Results In terms of the impact of pregnancy on SLE, 29.7% of patients had lupus flare during pregnancy. Multivariate analysis showed that flare rates were significantly higher in patients who discontinued the immunosuppressants when pregnancy was detected or before pregnancy. Pregnancy results were 25.0% for preterm birth, 39.1% for low birth weight infants, and 31.3% for small-for-gestational-age infants. Regarding the effect of SLE on fetal death, the rates of stillbirth were significantly higher in cases whose C3 value at 12 weeks of gestation was lower than before conception. Preterm birth was associated with disease duration and lupus flare during pregnancy. Conclusions Discontinuation of immunosuppressive drugs was a predictive factor for lupus flare during pregnancy. Further, the decrease of C3 levels at 12 weeks of gestation from baseline was a predictive factor for fetal loss. It is essential for lupus pregnant patients to prevent flares, even with the use of immunosuppressive medications.

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