THU0273 DISEASE ACTIVITY IS IMPORTANT RISK FACTORS FOR MATERNAL AND FETAL OUTCOMES DURING PREGNANCY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 363-363
Author(s):  
J. W. Kim ◽  
J. Y. Jung ◽  
H. A. Kim ◽  
C. H. Suh
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Odds Ratio ◽  
Systemic Lupus ◽  
Steroid Dose ◽  
Adverse Pregnancy

Background:Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and disease activity frequently increase during pregnancy. Patient with SLE still have markedly higher risk for obstetric complications, despite discussing reproductive planning with physicians and choosing a suitable time for pregnancy.Objectives:This study aimed to examine the frequency and risk factors of complications occurring during pregnancy for women with SLE and compare with the general obstetric population.Methods:The medical records of patients with SLE and age-matched controls at Ajou University Hospital between January 1999 and June 2019 were collected and retrospectively analyzed. Clinical features and pregnancy complications for all pregnancy-related admissions for women with and without SLE were compared. Multivariate logistic regression analysis was performed to obtain the predictor of maternal and fetal adverse outcomes.Results:During this period, we analyzed 163 pregnancies in patients with SLE and 596 pregnancies in general population. Of these, except for body mass index (BMI), no other significant differences regarding demographic characteristics were noted between the groups. Lupus patients delivered significantly earlier(37 weeks + 0 days vs. 37 weeks + 6 days, p<0.001) and experienced more stillbirth (odds ratio (OR) 12.8), pre-eclampsia (OR 4.2), preterm labor (OR 2.6), emergency cesarean section (OR 2.5) and intrauterine growth retardation (odds ratio: 2.4) than age-matched controls. Using logistic regression, thrombocytopenia, low complement levels, high proteinuria, anti-ds DNA antibody positivity and high SLE Disease Activity Index (SLEDAI) were associated with maternal and fetal complications, whereas high cumulative steroid dose after SLE onset, high median steroid dose during pregnancy and history of cyclophosphamide treatment were only correlated with maternal complications. The area under the curve for SLEDAI score of adverse pregnancy outcome was 0.726 (95% CI 0.65-0.81) and cumulative steroid dose after SLE onset and median steroid dose during pregnancy for maternal outcome were 0.658 (95% confidence interval (CI) 0.55-0.76) and 0.750 (95% CI 0.65-0.85). The optimal cut-off value for SLEDAI was 4 and cumulative and median steroid dose were 2750mg and 6mg, respectively.Conclusion:Pregnant women with SLE have a higher risk of adverse pregnancy outcomes. Pregnancies should be delayed until disease activity is well controls (SLEDAI<4) for longer than 6 months.References:[1]L-W Kwok, LS Tam, TY Zhu, et al., Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus. Lupus 2010;20:781-791[2]E Sugawara, M Kato, Y Fugieda, et al., Pregnancy outcomes in women with rheumatic disease: a real-world observational study in Japan. Lupus 2019;28:1407-1416[3]M Clowse, M Jamison, E Myers, et al., A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 2008;199:127.e1-127.e6Disclosure of Interests:None declared

Do adverse pregnancy outcomes contribute to accelerated cardiovascular events seen in young women with systemic lupus erythematosus?

Lupus ◽  
2017 ◽  
Vol 26 (13) ◽  
pp. 1351-1367 ◽  
Author(s):  
M C Soh ◽  
C Nelson-Piercy ◽  
M Westgren ◽  
L McCowan ◽  
D Pasupathy
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Young Women ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Cardiovascular Events ◽  
Adverse Pregnancy Outcomes ◽  
Systemic Lupus ◽  
Adverse Pregnancy

Cardiovascular events (CVEs) are prevalent in patients with systemic lupus erythematosus (SLE), and it is the young women who are disproportionately at risk. The risk factors for accelerated cardiovascular disease remain unclear, with multiple studies producing conflicting results. In this paper, we aim to address both traditional and SLE-specific risk factors postulated to drive the accelerated vascular disease in this cohort. We also discuss the more recent hypothesis that adverse pregnancy outcomes in the form of maternal–placental syndrome and resultant preterm delivery could potentially contribute to the CVEs seen in young women with SLE who have fewer traditional cardiovascular risk factors. The pathophysiology of how placental-mediated vascular insufficiency and hypoxia (with the secretion of placenta-like growth factor (PlGF) and soluble fms-tyrosine-like kinase-1 (sFlt-1), soluble endoglin (sEng) and other placental factors) work synergistically to damage the vascular endothelium is discussed. Adverse pregnancy outcomes ultimately are a small contributing factor to the complex pathophysiological process of cardiovascular disease in patients with SLE. Future collaborative studies between cardiologists, obstetricians, obstetric physicians and rheumatologists may pave the way for a better understanding of a likely multifactorial aetiological process.

FRI0160 THE CORRELATION BETWEEN PREGNANCY, DISEASE ACTIVITY AND ADVERSE PREGNANCY OUTCOMES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 664.1-664
Author(s):  
C. Cetin ◽  
T. Saraç-Sivrikoz ◽  
M. Ateş-Tikiz ◽  
E. S. Torun ◽  
S. Zarali ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Postpartum Period ◽  
Adverse Pregnancy Outcomes ◽  
Systemic Lupus ◽  
Gynecology And Obstetrics ◽  
Pregnancy And Postpartum ◽  
Adverse Pregnancy

Background:Patients with systemic lupus erythematosus (SLE) can present with acute disease flares/exacerbations during pregnancy and postpartum period.1These flares can cause adverse pregnancy outcomes (APO).Objectives:In this study, our pregnant SLE cohort, which was under medical surveillance of both our Rheumatology and Gynecology and Obstetrics departments was analyzed. We intended to determine the effects of pregnancy on disease activity and the correlation between disease flares and adverse pregnancy outcomes.Methods:168 pregnancy data involving 136 patients with SLE meeting the ACR criteria were examined. Cumulative clinical, laboratory and serological parameters were described and disease activity and flares were calculated using SLEDAI-2K disease activity index during preconceptional six month period, during all trimesters of pregnancy, and during postpartum six month period. Patients with low lupus disease activity scores (LLDAS) during each of these periods were identified. Fetal/neonatal death, premature birth due to preeclampsia, eclampsia or HELLP syndrome, neonates small for gestational age were determined as adverse pregnancy outcomes. Relationship of APO with disease activity was studied and patients with APO were compared to patients without APO.Results:Mean SLEDAI-2K scores was 1.3±2.2 (0-16) during preconceptional six month period, 1.3±2.6 (0-16) during conception period, 1.7±3.2 (0-22) during first trimester, 1.4±2.7 (0-16) during second trimester, 1.5±3.3 (0-20) during third trimester and 3.5±5.4 (0-26) during postpartum six month period. Mean postpartum six month period SLEDAI-2K score was higher compared to the mean pregnancy SLEDAI-2K score (p<0.05). LLDAS was sustained in 79% of all pregnancies. 19% of pregnancies resulted in flares. 42% of these flares were severe and 58% were mild or moderate. 49% of severe flares occurred during the postpartum six month period and this percentage was significantly higher compared to each trimester (p<0.05). Most of the flares during pregnancy and postpartum period had mucocutaneous (37%), renal(35%) and hematological(25%) involvement.APO was observed in 34% of pregnancies (n=57). APO (+) group was characterized by significantly longer disease duration and higher disease activity in all periods compared to APO (-) group (142±70 vs 170±88 months, p<0.05). In APO (-) group, the proportion of patients with severe disease activity during all pregnancy periods and postpartum period was significantly low (%18 vs 35, p<0.05), while the proportion of patients with sustained LLDAS was much higher (%88 vs 70).Conclusion:Postpartum six-month period appears to have the highest risk for disease flares during SLE pregnancies. Disease activity during pregnancy increases the risk of APO. Patients with sustained LLDAS have significantly lower APO rates. In order to achieve a positive pregnancy outcome and lower maternal morbidity, regular follow up of patients during pregnancy and postpartum period by Rheumatology and Gynecology and Obstetrics Departments is necessary.References:[1]Eudy AM, et al. Ann Rheum Dis 2018;0:1–6. doi:10.1136/annrheumdis-2017-212535Disclosure of Interests:None declared

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.

Lupus Low Disease Activity State achievement is important for reducing adverse outcomes in pregnant patients with systemic lupus erythematosus

2020 ◽  
pp. jrheum.200802
Author(s):  
Ji-Won Kim ◽  
Ju-Yang Jung ◽  
Hyoun-Ah Kim ◽  
Jeong In Yang ◽  
Dong Wook Kwak ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Regression Analysis ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Systemic Lupus ◽  
Low Disease Activity ◽  
Adverse Pregnancy ◽  
Activity State

Objective This study aimed to examine the frequency and risk factors of complications during pregnancy in women with systemic lupus erythematosus (SLE). Methods The medical records of patients with SLE and age-matched controls at Ajou University Hospital were collected. Clinical features and pregnancy complications in women with SLE were compared to those in controls. Multivariate logistic regression analysis was performed to determine the predictors of adverse maternal and fetal outcomes. Results We analyzed 163 pregnancies in patients with SLE and 596 pregnancies in the general population; no significant differences regarding demographic characteristics were noted. Lupus patients experienced a higher rate of stillbirth (odds ratio [OR], 13.2), pre-eclampsia (OR, 4.3), preterm labor (OR, 2.6), intrauterine growth retardation (OR, 2.5), admission to neonatal intensive care unit (OR, 2.2) and emergency cesarean section (OR, 1.9) than control group. Multivariate regression analysis revealed that thrombocytopenia, low complement, high proteinuria, high SLE Disease Activity Index (SLEDAI), low Lupus Low Disease Activity State (LLDAS) achievement rate, and high corticosteroid dose were associated with adverse pregnancy outcomes. In the receiver operating characteristic curve analysis, the optimal cut-off value for the cumulative and mean corticosteroid doses were 3,500 mg and 6 mg, respectively. Conclusion Pregnant women with SLE have a higher risk of adverse pregnancy outcomes. Pregnancies are recommended to be delayed until achieving LLDAS and should be closely monitored with the lowest possible dose of corticosteroids.

Adverse pregnancy outcomes among multi-ethnic systemic lupus erythematosus patients in Malaysia

Lupus ◽  
2020 ◽  
Vol 29 (10) ◽  
pp. 1305-1313
Author(s):  
Syahrul S Shaharir ◽  
Suhaida A Maulana ◽  
Nor S Shahril ◽  
Rozita Mohd ◽  
Ruslinda Mustafar ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Lupus Anticoagulant ◽  
Pregnancy Loss ◽  
Systemic Lupus ◽  
Factors Associated ◽  
Adverse Pregnancy ◽  
Active Disease

Background Despite the improvement in the live birth rate among patients with systemic lupus erythematosus (SLE), they are still at an increased risk of adverse pregnancy outcomes (APOs). Objective To determine the prevalence and factors associated with APOs in the multi-ethnic SLE populations in Malaysia. Methodology: This was a retrospective review of the consecutive SLE patients who attended the outpatient clinic in two major rheumatology centres from January 2016 until December 2019 with complete pre-pregnancy, antenatal and intra-partum records. APOs include pregnancy loss, prematurity, pre-eclampsia, intra-uterine growth restriction (IUGR) and maternal death. Univariate and multivariable logistic regression with generalised estimating equation (GEE) analyses were performed to determine the factors associated with APOs. Results A total of 153 patients with 240 pregnancies were included and the majority of the patients were Malay (69.9%), followed by Chinese (24.2%) and Indian (5.9%). The prevalence of APOs was 61.7% with the commonest complication being prematurity (28.3%), followed by pregnancy loss (24.6%) and pre-eclampsia (21.8%). Logistic regression model-based GEE analysis revealed that the independent predictors of APOs were active haematological system during pregnancy, pre-pregnancy active disease, Indian patients and positive lupus anticoagulant. Hydroxychloroquine use was associated with lower APOs including pre-eclampsia, prematurity and IUGR in the univariate analyses but it was no longer significant in the GEE analysis. Conclusion The prevalence of APOs was high particularly among the Indian patients. Positive lupus anticoagulant and pre-pregnancy active disease were the factors strongly associated with APOs in our multi-ethnic cohort. Hydroxychloroquine may protect against APOs but further larger studies are needed to confirm this.

scholarly journals Disease activity index is associated with subclinical atherosclerosis in childhood-onset systemic lupus erythematosus

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Priscila B. S. Medeiros ◽  
Roberta G. Salomão ◽  
Sara R. Teixeira ◽  
Diane M. Rassi ◽  
Luciana Rodrigues ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Subclinical Atherosclerosis ◽  
Disease Activity Index ◽  
Uncontrolled Hypertension ◽  
Childhood Onset ◽  
Systemic Lupus

Abstract Background Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular events. The present study determined the prevalence of subclinical atherosclerosis in childhood-onset SLE using the carotid intima-media thickness (CIMT) measurement and investigated associations between traditional and nontraditional risk factors for atherosclerosis, such as medications, SLE Disease Activity Index - SLEDAI-2 K and SLICC-ACR damage index and CIMT. Methods Cross-sectional prospective study between 2017 and 2018. CIMT was assessed by ultrasonography. Data were collected by chart review, nutritional evaluation and laboratory tests and analyzed by Fisher, Wilcoxon-Mann-Whitney tests, multiple linear and log binomial regression. Results Twenty-eight patients (mean age 13.9 years, SD 3) were enrolled. The prevalence of subclinical atherosclerosis was 32% (95% CI 14.8, 49.4). The mean CIMT was 0.43 ± 0.035 mm. The most common traditional risk factors observed were dyslipidemia (82.1%), uncontrolled hypertension (14.2%), obesity (14.3%), and poor diet (78.6%). Uncontrolled hypertension (p = 0.04), proteinuria (p = 0.02), estimated glomerular filtration rate < 75 ml /min/1.73 m2 (p = 0.02) and SLEDAI-2 K > 5 (P = 0.04) were associated with subclinical atherosclerosis. SLEDAI-2 K > 5 maintained association with CIMT after adjusting for control variables. Conclusion Subclinical atherosclerosis is frequently observed in cSLE, mainly in patients with moderate to severe disease activity.

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