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.

Pregnancy outcomes in systemic lupus erythematosus (SLE) women

2019 ◽  
Vol 40 (3) ◽  
Author(s):  
Aida Kalok ◽  
Rizna Abdul Cader ◽  
Ima Indirayani ◽  
Abdul Kadir Abdul Karim ◽  
Shamsul Azhar Shah ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Preterm Delivery ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Systemic Lupus ◽  
Foetal Loss ◽  
Active Disease ◽  
In Pregnancy

Abstract Background Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory condition with multi-organ involvement predominantly affecting young women. There are very limited studies in pregnancy in Asian SLE patients and therefore we embarked on this study to identify pregnancy outcomes of Malaysian women with SLE. Materials and methods We performed a retrospective study of pregnancy outcomes in SLE patients in our institution from January 2007 to December 2014. A total of 71 pregnancies from 44 women were analysed. Results The mean age of our cohort was 30.5 ± 3.9 years. The rate of active disease at conception, antiphospholipid syndrome and lupus nephritis were 22.5%, 32.4% and 57.7% respectively. SLE flare occurred in 33 out of 71 pregnancies whereas 19 pregnancies were complicated with preeclampsia. The livebirth rate for our cohort was 78.9%, whilst preterm delivery was 42.9%. On univariate analysis, active disease and flare in pregnancy were both strongly associated with foetal loss and preterm delivery. Lupus nephritis (p = 0.011), SLE flare (p = 0.008) and antiphospholipid syndrome (p = 0.032) significantly increased the risk of preeclampsia. Aspirin and hydroxychloroquine were protective against foetal loss [odds ratio (OR) 0.12] and preeclampsia (OR 0.25), respectively. On multivariate analysis, active disease was a predictor of SLE flare (p = 0.002) and foetal loss (p = 0.018) and SLE flare was the main predictor of preterm delivery (p = 0.006). Conclusions Pregnancies in women with SLE should be planned and aspirin and HCQ use were beneficial in reducing adverse pregnancy outcomes.

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.

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.

Childhood-Onset Systemic Lupus Erythematosus: Antiphospholipid Antibodies in 37 Patients and Their First-Degree Relatives

PEDIATRICS ◽  
1993 ◽  
Vol 92 (6) ◽  
pp. 849-853
Author(s):  
Charles Molta ◽  
Olivier Meyer ◽  
Christine Dosquet ◽  
Marcela Montes de Oca ◽  
Marie-Claude Babron ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Clinical Manifestations ◽  
Fetal Loss ◽  
Childhood Onset ◽  
Systemic Lupus ◽  
First Degree Relatives ◽  
Antiphosphatidylethanolamine Antibodies ◽  
Onset Systemic Lupus Erythematosus

Objective. Antiphospholipid antibodies (aPL) are noted with increased frequency in patients with systemic lupus erythematosus (SLE). The main manifestations found to be associated with aPL are arterial and venous thrombotic events, thrombocytopenia, and recurrent pregnancy loss This study is an attempt to define the incidence of aPL in patients with childhood-onset SLE and in their relatives and to correlate their presence with clinical manifestations, and especially, to evaluate the risk of thrombosis in aPL-positive subjects. Methodology. We studied 37 unrelated patients and 107 of their first-degree relatives. VDRL, IgG and IgM anticardiolipin, and IgG antiphosphatidylethanolamine antibodies were studied in all probands during periods of clinical remission and in first-degree relatives at the time of interview. Lupus anticoagulant had only been studied in probands during an SLE flare-up. Results. Thirty-eight percent of probands and 19% of relatives were positive for at least one aPL, with little over-lap between the different aPL studied. -No aPL-negative proband developed thrombosis. Two of the aPL-positive probands had thrombotic events before testing, and a third one showed thrombosis after testing. Only two probands had high levels of IgG aCL and showed thrombosis. The occurrence of aPL positivity in relatives was not always related to its presence in probands. None of the aPL-positive relatives had hadthrombosis, but recurrent fetal loss was noted in one aPL-positive mother with SLE. Although there was a high frequency of SLE, SLE-like disease, auto-immune disorders or positive serological findings for lupus in first-degree relatives, many of these relativew did not test positive for aPL. Conclusion. The high levels of IgG aCL may be considered a risk factor for thrombosis. Findings in relatives suggest a multifactorial origin for autoimmune disease and antibody production.

SLEDAI-2K Does Not Conceal Worsening in a Particular System When There Is Overall Improvement

2015 ◽  
Vol 42 (8) ◽  
pp. 1401-1405 ◽  
Author(s):  
Zahi Touma ◽  
Dafna D. Gladman ◽  
Jiandong Su ◽  
Dominique Ibañez ◽  
Murray B. Urowitz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Disease Activity Index ◽  
Systemic Lupus Erythematosus Disease ◽  
Systemic Lupus ◽  
Baseline Visit ◽  
Clinically Significant ◽  
Active Disease

Objective.To determine whether the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) is valid in identifying patients who had a clinically important overall improvement with no worsening in other descriptors/systems.Methods.Consecutive patients with systemic lupus erythematosus with active disease who attended the Lupus Clinic between 2000 and 2012 were studied. Based on the change in the total SLEDAI-2K scores on last visit, patients were grouped as improved, flared/worsened, and unchanged. Patients showing improvement were evaluated for the presence of new active descriptors at last visit compared with baseline visit.Results.Of the 158 patients studied, 109 patients had improved, 38 remained unchanged, and 11 flared/worsened at last visit. In the improved group, 11 patients had a new laboratory descriptor that was not present at baseline visit. In those 11 patients, this new laboratory descriptor was not clinically significant and did not require a change in disease management.Conclusion.The SLEDAI-2K identifies improvement in disease activity overall without concealing clinically important worsening.

scholarly journals Prediction of Adverse Pregnancy Outcomes in Women with Systemic Lupus Erythematosus

2019 ◽  
Vol 59 (3) ◽  
pp. 287-294 ◽  
Author(s):  
Catarina R. Palma dos Reis ◽  
Gonçalo Cardoso ◽  
Carolina Carvalho ◽  
Isabel Nogueira ◽  
Augusta Borges ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Systemic Lupus ◽  
Adverse Pregnancy

Cut off point of neutrophil-to-lymphocyte ratio as a marker of active disease in systemic lupus erythematosus

Lupus ◽  
2020 ◽  
Vol 29 (12) ◽  
pp. 1566-1570
Author(s):  
Akhmad Syaikhu Firizal ◽  
Adhi Kristianto Sugianli ◽  
Laniyati Hamijoyo
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Activity Index ◽  
Disease Activity Index ◽  
Neutrophil To Lymphocyte Ratio ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Lymphocyte Ratio ◽  
Active Disease

Aim We aimed to measure sensitivity, specificity, and to determine the cut-off value (COV) ratio of neutrophil-to-lymphocyte (NLR) in patients with active systemic lupus erythematosus (SLE). Methods A cross sectional study was conducted using the retrospective data from Hasan Sadikin Lupus Registry (HSLR). The inclusion criteria were SLE patients aged 18 years or older who had documented data of neutrophil, lymphocyte, and SLE disease activity index (SLEDAI). Patients with infections, malignancies, and other inflammatory diseases recorded in registry were excluded. SLEDAI with a score of ≤ 4 is considered inactive and score of > 4 is considered active. The neutrophil-to-lymphocyte ratio was calculated by dividing the absolute number of neutrophils by the absoulte number of lymphocytes. Receiver Operating Characteristic (ROC) curve was used to analyze and determine optimal COV of NLR. Results The total sample in this study were 112 subjects with a dominant of female (95.54%) and the mean age of 34.45 ± 9.40 years. The median of SLEDAI was 4.5 with a range from 0 to 16, while the median of NLR was 2.68 with a range of 0.59 to 19.02. The ROC analysis showed the optimal cut-off in this study was 2.94 with sensitivity and specificity as high as 60.71% and 76.79%, respectively. Conclusion Neutrophil-to-lymphocyte ratio with cut off value of 2.94 can be used to determine active disease of systemic lupus eythematousus.

scholarly journals High IgA antiphospholipid autoantibodies in healthy Sudanese explain the increased prevalence among Sudanese compared to Swedish systemic lupus erythematosus patients

Lupus ◽  
2020 ◽  
Vol 29 (11) ◽  
pp. 1412-1422 ◽  
Author(s):  
Sahwa Elbagir ◽  
Amir I Elshafie ◽  
Elnour M Elagib ◽  
NasrEldeen A Mohammed ◽  
Mawahib IE Aledrissy ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
South African ◽  
Lupus Erythematosus ◽  
Fetal Loss ◽  
African Origin ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
Glycoprotein I ◽  
High Prevalence ◽  
Clinical Associations

Objectives IgA antiphospholipid antibodies (aPL) are prevalent in systemic lupus erythematosus (SLE) patients of African American, Afro-Caribbean and South African origin. Nevertheless, data from North Africa are lacking, and most studies use manufacturer-suggested cut-offs based on Caucasian controls. Therefore, we compared aPL isotypes in Sudanese and Swedish SLE patients using nation-based cut-offs. Methods Consecutive SLE patients and age- and sex-matched controls from Sudan ( N = 115/106) and Sweden ( N = 340/318) were included. All patients fulfilled the 1982 American College of Rheumatology SLE classification criteria. Antiphospholipid syndrome–related events were obtained from patients’ records. IgA/G/M anticardiolipin and anti-β2 glycoprotein I (β2GPI) were analysed with two independent assays. IgA anti-β2GPI domain 1 (D1) was also investigated. Manufacturers’ cut-offs and the 95th and 99th percentile cut-offs based on national controls were used. Results Sudanese patients and controls had higher levels and were more often positive for IgA aPL than Swedes when using manufacturers’ cut-offs. In contrast, using national cut-offs, the increase in IgA aPL among Sudanese patients was lost. Occurrence of IgA anti-D1 did not differ between the countries. Venous thromboses were less common among Sudanese patients and did not associate with aPL. No clinical associations were observed with IgA anti-β2GPI in Sudanese patients. Thromboses in Swedes were associated with IgG/M aPL. Fetal loss was associated with aPL in both cohorts. Conclusions IgA anti-β2GPI prevalence was higher among Sudanese compared to Swedish patients when manufacturers’ cut-offs were used. This situation was reversed when applying national cut-offs. Anti-D1 was not increased in Sudanese patients. Previous studies on populations of African origin, which demonstrate a high prevalence of IgA aPL positivity, should be re-evaluated using a similar cut-off approach.

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