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

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.

scholarly journals Maternal and Fetal Outcomes in Systemic Lupus Erythematosus Pregnancies

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

scholarly journals AB0338 PREGNANCY OUTCOMES IN ADOLESCENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1194.1-1194
Author(s):  
P. Alba ◽  
Y. Tissera ◽  
N. Cucchiaro ◽  
V. Savio ◽  
R. Serrano Morales ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Adolescent Pregnancy ◽  
Pregnancy Outcome ◽  
Young Women ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Fetal Outcome ◽  
Maternal Outcomes ◽  
Systemic Lupus ◽  
Fetal Outcomes

Background:Systemic lupus erythematosus (SLE) is a autoimmune disease that affects adolescents and young women of childbearing age. In spite of the improvement in fetal and maternal SLE pregnancy outcome in the last decades, they have increased risk of adverse outcomes including disease flare, abortions, preeclampsia (PE) and premature birth (PB). However, pregnancy outcomes among adolescents with SLE have not been well explored.Objectives:To evaluate maternal and fetal outcomes in pregnant adolescents with SLE.Methods:We retrospectively studied all pregnant SLE adolescent patients, who attended to 3 Maternity Hospitals in Argentina in the last 5 years. Demographic, clinical, and laboratory data were collected. The presence of Antiphospholipid Syndrome (APS) and the Antiphospholipid antibodies (AA), and maternal and fetal outcome were evaluated. Adolescent pregnancy was defined it is happened between 10 and 19 years old. Lupus activity was evaluated by SELENA SLEDAI at the conception and each trimester of pregnancy and puerperium.Results:32 pregnancies in 21 patients were included. Mean age was 18 years old, 66% was mestizo ethnicity and mean disease duration of 2 years. Renal involvement was found in 19, Mucocutaneous in 21, and hematological in 14 patients. 4 patients had positive Anti-SSA/Ro antibodies, 1 Anti-SSB/La, 2 Lupus anticoagulant, 6 Ig G ACL, 3 Ig M ACL, and 8 patients fulfilled APS criteria. Activity disease was 0 SELENA SLEDAI in 1 ° trimester, 4 in 2°,3° trimester and puerperium. Maternal and fetal outcomes are shown in Table 1. Cesarean section was performed in 58%(n=18) of the patients, 6 had abortions and 1 fetal death.Table 1.Maternal outcomesDisease Flares13(41%) 7 renal (PE)/Hellp6 (19%)Gestational Diabetes1 (3%)Maternal outcomesSpontaneous Membrane Rupture1 (3%)Mortality0Fetal outcomeLive birth24 (75%)Gestational age (weeks)32 (32-38)Weight (grs)2805 (2100-3340)IUGR5 (16%)PB8 (25%)Conclusion:Maternal and fetal complications were high in adolescent pregnancy with SLE, including disease activity, PE and PB. A tight control of patients should be performed before and after conception. These patients should be managed by a multidisciplinary team, thus allowing an improvement of maternal and fetal prognosis.References:[1]Ling N, Lawson E, von Scheven E. Adverse Pregnancy outcome in adolescents and young women with systemic lupus erythematosus: a national estimate. Pediatric Rheumatology 2018, 16:26.[2]FraserA, Brockert J, Ward R: Association of young maternal age with adverse reproductive outcomes. N Engl J Med 1995, 223:1113-1117. 26.Disclosure of Interests:None declared

Extraglomerular immune complex deposition in lupus nephritis

Lupus ◽  
2021 ◽  
pp. 096120332110625
Author(s):  
Valentina Papa ◽  
James Brainer ◽  
Kammi J Henriksen ◽  
Giovanna Cenacchi ◽  
Anthony Chang
Keyword(s):  
Electron Microscopy ◽  
Systemic Lupus Erythematosus ◽  
Retrospective Study ◽  
Lupus Nephritis ◽  
Immune Complex ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Immune Complex Deposition ◽  
Complex Deposition ◽  
Common Manifestation

Background Lupus nephritis (LN) is a common manifestation and a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. It is characterized by glomerular and often extraglomerular immune complex deposition. Purpose Given the emerging importance of the tubulointerstitial compartment, we conducted a retrospective study of 78 LN biopsies to enumerate the spectrum of extraglomerular immune complex deposition that can be observed in lupus nephritis by electron microscopy and to identify possible clinical or pathologic correlates. Results The presence of tubulointerstitial immune complex deposition often accompanied interstitial inflammation, but some discrepancies were also seen. Conclusions As target antigens are identified, correlation with glomerular, tubulointerstitial, and vascular immune complex deposition will be of increasing interest.

The impact of different classes of lupus nephritis on maternal and fetal outcomes: a cohort study of 147 pregnancies

Lupus ◽  
2019 ◽  
Vol 28 (4) ◽  
pp. 492-500 ◽  
Author(s):  
B Costa Rodrigues ◽  
M Ignacchiti Lacerda ◽  
G R Ramires de Jesús ◽  
Flávia Cunha dos Santos ◽  
N Ramires de Jesús ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Damage Index ◽  
Categorical Variables ◽  
Systemic Lupus ◽  
Fetal Outcomes ◽  
American College Of Rheumatology ◽  
The Impact

Objective To analyze the impact of different classes of lupus nephritis as risk variables for maternal and fetal adverse outcomes in a cohort of pregnant lupus patients. Methods This is a cohort study with retrospective and prospective data collection, conducted at the University Hospital of State University of Rio de Janeiro, Brazil, from 2011 to 2016. A total of 147 pregnancies of 137 systemic lupus erythematosus patients of whom 66 had lupus nephritis were included. Demographic and clinical features, as well as maternal and fetal outcomes were observed for each nephritis histological class among systemic lupus erythematosus patients and compared with those without nephritis. Categorical variables were expressed as absolute and relative frequencies and numerical variables as means and standard deviation. The chi-square test with Fisher's correction and Student's t-test were used for statistical analysis. A pvalue < 0.05 was considered statistically significant. Results Systemic lupus erythematosus patients with proliferative nephritis (classes III/IV, n = 54) presented more frequent disease flares ( p = 0.02), continuous active disease during pregnancy and puerperium ( p = 0.006), hospitalization due to systemic lupus erythematosus ( p < 0.001), hospitalization not directly associated to systemic lupus erythematosus ( p = 0.04), higher frequency of cesarean delivery ( p = 0.03) and preeclampsia ( p = 0.01) than patients without nephritis. Permanent damage measured by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was more frequent in classes III/IV than among the other patients. The frequency of adverse fetal outcomes such as prematurity and admission to neonatal intensive care unit were not different among systemic lupus erythematosus patients with or without nephritis. However, perinatal deaths were more frequent in patients with all classes of nephritis ( p = 0.003). Conclusion Systemic lupus erythematosus patients with proliferative nephritis (classes III/IV) have a higher frequency of adverse maternal outcomes. This is probably due to the major impact of proliferative forms of nephritis on women's global heath, which is corroborated by the higher Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index findings, although we cannot exclude the negative influence of disease activity for the maternal adverse events. The findings indicate a need for further lupus nephritis classification beyond the nonspecific term nephritis in the context of lupus pregnancy as the impact on maternal and fetal outcomes varies according to histological class.

THE CLINICAL, LABORATORY MANIFESTATIONS AND HISTOPATHOLOGY IN NEPHROTIC PATIENTS WITH LUPUS NEPHRITIS

2018 ◽  
pp. 52-58
Author(s):  
Le Thuan Nguyen ◽  
Bui Bao Hoang
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Clinical Laboratory ◽  
Activity Index ◽  
Clinical Manifestations ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Organ Systems ◽  
Tubulointerstitial Lesions

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organ systems. The kidney appears to be the most commonly affected organ, especially nephrotic is a serious kidney injury. The clinical, laboratory manifestations and histopathology are very useful for diagnosis, provide the means of predicting prognosis and guiding therapy in nephrotic patients with lupus nephritis. Methods: Descriptive cross-sectional study of nephrotic patients with lupus treated in the Department of Nephrology Trung Vuong Hospital and Cho Ray Hospital between May/2014 and May/2017. Renal histopathological lesions were classified according to International Society of Nephrology/Renal Pathology Society - ISN/RPS ’s 2003. The clinical, laboratory manifestations and histopathological features were described. Results: Of 32 LN with nephritic range proteinuria cases studied, 93.7% were women. The 3 most common clinical manifestations were edema (93.8%), hypertension (96.8%) and pallor (68.9%), musculoskeletal manifestions (46.9%), malar rash (40.6%). There was significant rise in laboratory and immunological manifestions with hematuria (78.1%), Hb < 12g/dL (93.5%), increased Cholesterol (100%), and Triglycerid (87.5%), Creatinine > 1.4 mg/dL (87.5%), increased BUN 71.9%, ANA (+) 93.8%, Anti Ds DNA(+) 96.9%, low C3: 96.9%, low C4: 84.4%. The most various and severe features were noted in class IV with active tubulointerstitial lesions and high activity index. Conclusion: Lupus nephritis with nephrotic range proteinuria has the more severity of histopathological feature and the more severity of the more systemic organ involvements and laboratory disorders were noted. Key words: Systemic lupus, erythematosus (SLE) lupus nepphritis, clinical

scholarly journals Assessment of serum macrophage migration inhibitory factor (MIF), adiponectin, and other adipokines as potential markers of proteinuria and renal dysfunction in lupus nephritis: a cross-sectional study

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Jorge Ivan Gamez-Nava ◽  
Valeria Diaz-Rizo ◽  
Edsaul Emilio Perez-Guerrero ◽  
Jose Francisco Muñoz-Valle ◽  
Ana Miriam Saldaña-Cruz ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Linear Regression ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Macrophage Migration Inhibitory Factor ◽  
Cross Sectional Study ◽  
Macrophage Migration ◽  
Sectional Study ◽  
Systemic Lupus ◽  
Cross Sectional

Abstract Background To date, the association of serum macrophage migration inhibitory factor (MIF) and serum adipokines with lupus nephritis is controversial. Objective To assess the utility of serum MIF, leptin, adiponectin and resistin levels as markers of proteinuria and renal dysfunction in lupus nephritis. Methods Cross-sectional study including 196 systemic lupus erythematosus (SLE) patients and 52 healthy controls (HCs). Disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Renal SLE involvement was investigated by renal-SLEDAI. MIF, adiponectin, leptin and resistin levels were quantified by ELISA. We assessed the correlations of quantitative variables by Spearman correlation (rs). Multivariable linear regression adjusted the variables associated with the severity of proteinuria. Results SLE patients had higher MIF (p = 0.02) and adiponectin (p < 0.001) than HCs. Patients with renal SLE involvement (n = 43) had higher adiponectin (19.0 vs 13.3 μg/mL, p = 0.002) and resistin (10.7 vs 8.9 ng/mL, p = 0.01) than patients with non-renal SLE (n = 153). Proteinuria correlated with high adiponectin (rs = 0.19, p < 0.009) and resistin (rs = 0.26, p < 0.001). MIF (rs = 0.27, p = 0.04). Resistin correlated with increased creatinine (rs = 0.18, p = 0.02). High renal-SLEDAI correlated with adiponectin (rs = 0.21, p = 0.004). Multiple linear regression showed that elevated adiponectin (p = 0.02), younger age (p = 0.04) and low MIF (p = 0.02) were associated with the severity of proteinuria. Low MIF and high adiponectin levels interacted to explain the association with the severity of proteinuria (R2 = 0.41). Conclusions High adiponectin combined with low MIF concentrations int+eract to explain the severity of proteinuria in renal SLE. These findings highlight the relevance of adiponectin, resistin and MIF as markers of LN.

scholarly journals SAT0211 RENAL INJURY IN SYSTEMIC LUPUS ERYTHEMATOSUS CHARACTERIZED BY THROMBOTIC MICROANGIOPATHY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1048.1-1048
Author(s):  
W. Hu
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Lupus Erythematosus ◽  
Thrombotic Microangiopathy ◽  
Renal Injury ◽  
Renal Outcome ◽  
Pathological Examination ◽  
Systemic Lupus ◽  
Tubulointerstitial Lesions

Background:Classical lupus nephritis (LN) is characterized by glomerular immune complex(IC) deposition with glomerular proliferation, basement membrane destruction and cell infiltration. Non-IC mediated renal injury with thrombotic microangiopathy (TMA) was also reported in patients with systemic lupus erythematosus (SLE-renal TMA), but most studies were reported in patients with both LN and renal TMA.Objectives:In this study, clinical features and outcomes of SLE-renal TMA in absence of obvious IC in SLE patients were analyzed.Methods:Patients with glomerular TMA and/or vascular TMA in the absence of obvious subendothelial or epithelial immune deposits were screened out from 2332 biopsied in SLE patients who underwent first renal biopsy from January 2005 to August 2016. Their clinical, histological features and outcomes were retrospectively analyzed.Results:In 2332 renal biopsies obtained from SLE patients, 257 (11.0%) showed renal TMA, of which 237 showed both renal TMA and LN, and 20 biopsies had only renal TMA (SLE-renal TMA). There were 2 males and 18 females with an average age of (25 ± 10) years. The median course of SLE and LN were 3.0(1.0, 6.0) and 0.8(0.5, 1.9) months. All 20 patients deserved acute kidney injury, of which 11 (55%) needed renal replacement therapy (RRT) and 12 (60%) were nephrotic syndrome. Blood system involvement was found in all cases, including 13 cases (65.0%) with TMA triad (microvascular hemolytic anemia, thrombocytopenia and elevated lactate dehydrogenase).Pathological examination showed that 17 cases (85.0%) had both glomerular TMA and vascular TMA. Immunofluorescence and electron microscopy showed that 8 cases (40%) had no IC deposition in glomerulus and 12 cases (60%) had only IC deposition in mesangium. Acute tubulointerstitial lesions in patients requiring RRT were more serious than those no needing for RRT((43.6±24.9) %vs(21.7±20.1) %,P=0.047). The fusion range of foot process was positively correlated with proteinuria (r2= 0.347,P=0.006).All patients received high-dose methylprednisolone pulse therapy. Four patients received plasma exchange and three patients received gamma globulin, respectively. Eleven patients requiring RRT all stop RRT in a median time of 16.0 (9.0, 30.0) days. During a median follow-up of 58.0 (36.0, 92.3) months, complete remission (CR) was obtained in 15 cases, partial remission in 4 cases and no remission in 1 case. Six cases (30%) relapsed. No case died or progressed to end stage renal disease.Conclusion:Renal injury characterized by TMA is not uncommon in SLE renal biopsy cases. The clinical manifestation is special and the renal injury is serious. The renal outcome is good by intensive immunosuppressive therapy. It should be considered as a unique type of renal injury in SLE.References:[1]Moake JL. Thrombotic microangiopathies. N Engl J Med. 2002. 347(8): 589-600.[2]Anders HJ, Weening JJ. Kidney disease in lupus is not always ‘lupus nephritis’. Arthritis Res Ther. 2013. 15(2): 108.[3]Song D, Wu LH, Wang FM, et al. The spectrum of renal thrombotic microangiopathy in lupus nephritis. Arthritis Res Ther. 2013. 15(1): R12.[4]Hu WX, Liu ZZ, Chen HP, Zhang HT, Li LS, Liu ZH. Clinical characteristics and prognosis of diffuse proliferative lupus nephritis with thrombotic microangiopathy. Lupus. 2010. 19(14): 1591-8.[5]Tomov S, Lazarchick J, Self SE, Bruner ET, Budisavljevic MN. Kidney-limited thrombotic microangiopathy in patients with SLE treated with romiplostim. Lupus. 2013. 22(5): 504-9.[6]Li C, Yap D, Chan G, et al. Clinical Outcomes and Clinico-pathological Correlations in Lupus Nephritis with Kidney Biopsy Showing Thrombotic Microangiopathy. J Rheumatol. 2019 .[7]Chen MH, Chen MH, Chen WS, et al. Thrombotic microangiopathy in systemic lupus erythematosus: a cohort study in North Taiwan. Rheumatology (Oxford). 2011. 50(4): 768-75.[8]Park MH, AUID- Oho, Caselman N, Ulmer S, Weitz IC, AUID- Oho. Complement-mediated thrombotic microangiopathy associated with lupus nephritis. Blood Adv. 2018. 2(16): 2090-2094.Disclosure of Interests:None declared

scholarly journals Pattern and prevalence of neuropsychiatric lupus: a retrospective study from a tertiary level hospital in Bangladesh

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Fahima Hossain ◽  
Mohammad Delwer Hossain Hawlader ◽  
Dipak Kumar Mitra ◽  
Mohammad Hayatun Nabi ◽  
Md. Mujibur Rahman
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Retrospective Study ◽  
Cognitive Dysfunction ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Tertiary Care ◽  
Care Hospital ◽  
Systemic Lupus ◽  
Case Definitions ◽  
American College Of Rheumatology

Abstract Background Neuropsychiatric systemic lupus erythematosus (NPSLE) is well known for its varying presentations and poor outcomes, but little is evident about its distribution and characteristics among the Bangladeshi population. This study aimed to assess the pattern and prevalence of neuropsychiatric symptoms in female systemic lupus erythematosus (SLE) patients of Bangladesh. A retrospective study was conducted at a tertiary care hospital in Dhaka, Bangladesh, between January and December 2018. One hundred female SLE patients were included in the study purposively. Data were collected on sociodemographic and clinical characteristics of diagnosed SLE cases visiting the SLE clinic and indoor medicine department. Neuropsychiatric (NP) syndromes were defined according to the widely accepted American College of Rheumatology (ACR) nomenclature and case definitions. Results A total of 244 NP events were identified in fifty-five patients. Headache was the most frequent symptom (55%), followed by cognitive dysfunction (50%), anxiety (49%), psychosis (43%), seizure (23%), depression (17%), and cerebrovascular disease (ischemic type, 7%). The NP manifestations were more prevalent among urban residents (58.2%), younger patients (41.8%), and patients with graduate-level education (34.5%). Besides, young age at diagnosis (p = 0.038), Raynaud’s phenomenon (p = 0.015), other organ involvement (p < 0.001), and time of NPSLE development (p < 0.001) were found to be significantly associated with the development of these manifestations. Conclusion NP damage is prevalent among Bangladeshi female SLE patients (55%) with headache and cognitive dysfunction being the most common symptoms. Routine screening for neuropsychiatric symptoms among suspected SLE cases and further evaluation with a larger population are warranted.

scholarly journals THU0268 NEURO-DEVELOPMENTAL OUTCOME IN CHILDREN BORN TO MOTHERS WITH SLE AND APS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 360.1-361
Author(s):  
M. Hassanien ◽  
E. Talaat ◽  
H. Abdellatif
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Memory Impairment ◽  
Activity Index ◽  
Reproductive Age ◽  
Developmental Outcome ◽  
Systemic Lupus ◽  
Recent Memory ◽  
Children's Memory ◽  
Children's Memory Scale

Background:Systemic Lupus erythematosus and antiphospholipid disease are very common autoimmune diseases in women at reproductive age.Objectives:Evaluate the neuro-developmental outcome in children born to mothers with SLE or APS and to assess and characterize memory impairment in children’s born to mother with systemic lupus erythematosus or APS using children’s memory scale and the relation between tetrahydrobiopterin concentration range of children with developmental and neurological disorders.Methods:Women attending rheumatology clinics University of Asyut, SLE patients were eligible if they met the American College of Rheumatology (ACR) criteria for SLE and APL prior to pregnancy, and had at least one live birth following SLE diagnosis. Maternal history Data collected using a structured format that included medical and obstetric history. A detailed history of medication exposures and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) during pregnancy was obtained. Offspring history Medical and developmental histories of the offspring including antenatal, delivery, prenatal and pediatric histories, as child’s cognitive, physical or social maturity compared with established age-appropriate norms. Speech or hearing delays, diagnosis of attention- deficit hyperactivity disorder (ADHD), or any special educational needs (eg, occupational or speech therapy, behavioral counseling) was recorded. Assessment and characterization of memory impairment using children’s memory scale by neurologists. Tetrahydrobiopterin was measured by ELISA compared to children born to control healthy subjects of the same age and sex.Results:Data on 38 mothers and 60 offspring were analysed: ADHD was reported for 15 of 60 (25%) offspring. Recent memory delay was detected in 93% (14/15) Speech delay 40% (6/15). Maternal APS history was significantly associated with increased use special educational need among offsprings, including after adjustment for lupus anticoagulant (LA) positivity (39.4% for delays age >2 years; p<0.05). Anticardiolipin and anti-BETA2GP1 were not detected to be associated with delays. Recent memory delay was associated with increased Tetrahydrobiopterin level (P=0.01).Conclusion:The prevalence of neurodevelopmental abnormalities in children born to mothers with SLE or APS seems to be higher than normal population and more educational attention is important in these children, and need long-term follow-up.Disclosure of Interests:None declared

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