FRI0406 Maternal and Fetal Outcomes in Pregnant Systemic Lupus Erythematosus Patients: an Incident Cohort from A Stable Referral Population Followed during 1990-2010

It is well known that pregnancy in a woman with systemic lupus erythematosus (SLE) is associated with an increased risk of adverse maternal and fetal outcomes. But what about the risk in patients with isolated cutaneous lupus erythematosus (CLE) during pregnancy? There are insufficient data on clinical obstetrical and neonatal outcomes in women with CLE and very few studies have been published concerning the obstetric prognosis in the various types of cutaneous lupus. We report the case of a 24-year-old woman with no known pathological history, who presented with a severe and inaugural flare-up of a typical acute lupus erythematosus (ACLE) without systemic involvement which was complicated by a fetal loss.

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Maternal and Fetal Outcomes in Systemic Lupus Erythematosus Pregnancies

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2020373 ◽

2020 ◽

Vol 49 (12) ◽

pp. 963-970

Author(s):

Yih Jia Poh ◽

Irene Yuen Lin Yii ◽

Lim Hee Goh ◽

Hui Hua Li ◽

Liying Yang ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Preterm Delivery ◽

Fetal Growth ◽

Lupus Erythematosus ◽

Fetal Growth Restriction ◽

Maternal Outcomes ◽

Systemic Lupus ◽

Fetal Outcomes ◽

The Mean

Abstract Introduction: To describe the maternal and fetal outcomes in systemic lupus erythematosus (SLE) pregnancies followed-up in a single tertiary referral centre. Methods: We performed a retrospective cohort study of 75 SLE pregnancies who were followed up in Singapore General Hospital over a 16-year period from 2000 to 2016. Adverse fetal and maternal outcomes including preterm delivery, miscarriages, fetal growth restriction, congenital heart block, neonatal lupus, pre-eclampsia and SLE flares were obtained from the medical records. Results: The mean age at conception was 32 years old (SD 3.8). The mean SLE disease duration was 5.9 years (SD 5.2). The majority (88%) had quiescent SLE disease activity at baseline. Most pregnancies resulted in a live birth (74.7%). The mean gestational age at birth was 37.4 weeks (SD 3.4). Adverse fetal outcomes occurred in 53.3%. Preterm delivery (33.9%), miscarriages (20%) and fetal growth restriction (17.3%) were the most frequent adverse fetal outcomes. There was 1 neonatal death and SLE flares occurred in a third (33%). In the subgroup of SLE pregnancies with antiphospholipid syndrome, there were higher SLE flare rates (40%) and adverse fetal outcomes occurred in 8 pregnancies (80%). There were no predictive factors identified for all adverse fetal and maternal outcomes. In the subgroup analysis of preterm delivery, anti-Ro (SS-A) antibody positivity and hydroxychloroquine treatment were associated with a lower risk of preterm delivery. Conclusion: Although the majority had quiescent SLE disease activity at baseline, SLE pregnancies were associated with high rates of adverse fetal and maternal outcomes. Keywords: Antiphospholipid syndrome, anti-La (SS-B) antibody, anti-Ro (SS-A) antibody, lupus nephritis

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Maternal and Fetal Outcomes in Iranian Patients with Systemic Lupus Erythematosus: A Five-Year Retrospective Study of 60 Pregnancies

Current Rheumatology Reviews ◽

10.2174/1573397115666190125162248 ◽

2019 ◽

Vol 15 (4) ◽

pp. 321-328

Author(s):

P. Karimzadeh ◽

S. Shenavandeh ◽

N. Asadi

Keyword(s):

Systemic Lupus Erythematosus ◽

Retrospective Study ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

Medical Science ◽

Reproductive Age ◽

Long Term Results ◽

Maternal Outcomes ◽

Systemic Lupus ◽

Fetal Outcomes

Background: As a multisystem autoimmune disease, Systemic Lupus Erythematosus (SLE) mainly affects women during reproductive age. This retrospective study was designed to investigate the fetal and maternal outcomes of Iranian women with SLE. Methods: Clinical and laboratory records of 60 pregnancies in 55 SLE patients who attended Hafez hospital, a tertiary referral center for high risk pregnancies and SLE patients affiliated with Shiraz University of Medical Science, were reviewed during April 2012 and March 2016. Results: The mean age of the patients was 29.28±4.6 years and mean disease duration was 5.09±4.2 years. Live birth rate was 83.3% after exclusion of elective abortions. There were 50 live births, 3 neonatal deaths, 3 spontaneous abortions and 7 stillbirths. 9 (15%) women developed preeclampsia and there was 1 (1.6%) case of HELLP syndrome. Lupus flares occurred in 27 (45%) patients during pregnancy. Preterm delivery occurred in 11.6% of pregnancies. Skin and joints were the most frequently affected organs. Patients with previous lupus nephritis (n=18) were associated with a higher risk of maternal complication, but fetal outcomes were similar in both groups. Cesarean rate was about 66%, mostly related to fetal indications (50%). Conclusion: Pregnancies in most women with pre-existing SLE can now be managed with successful results although presence of previous lupus nephritis is still a major risk factor for adverse maternal outcomes. In our study, fetal outcome was not different between patients with lupus nephritis compared with the patients without nephritis who were under treatments. Hence, to achieve favorable long-term results, we recommend regular multispecialty treatment approaches and progestational counseling for women with SLE.

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