General Obstetrics and Gynecology: Obstetrics
Pregnancy outcomes before and after a diagnosis of systemic lupus erythematosus

https://doi.org/10.1016/j.ajog.2005.02.104Get rights and content

Objective

The purpose of this study was to evaluate pregnancy outcomes before and after diagnosis of lupus.

Study design

Successive selection criterion applied to 148 lupus and 78,905 non-lupus pregnancies, generated 3 groups: lupus group, 84 pregnancies (not-yet-diagnosed group, 15 women; already-diagnosed group, 69 women), and control group, 51,000 pregnancies. Three-way analysis of variance and the chi-squared test were used for analyses.

Results

Stillbirth outcome was increased in the lupus group compared with the control group (odds ratio, 4.84 [95% CI, 1.72,11.08]); the not-yet-diagnosed group (odds ratio, 9.89 [95% CI, 1.09,42.63]), and the already-diagnosed group (odds ratio, 3.85 [95% CI, 1.02,10.31]). Considering >1 pregnancy per patient would have overestimated the stillbirth rate. Stillbirth risk was increased significantly in severe maternal disease that was marked by central nervous system involvement. The already-diagnosed group had more hypertensive complications (P = .001 and .0001). Both lupus groups showed a significantly greater proportion of preterm births (P = .03), growth restriction (P = .019), and infants in the very low birth weight category (P = .021) compared with the control group.

Conclusion

Poor fetal outcomes are seen in pregnancies that are complicated by lupus, even before clinical appearance of disease, which supports a predisease state.

Section snippets

Material and methods

After approval by our Human Investigation Committee, computerized records of the Wayne State University/Hutzel Hospital Perinatal Database were examined. All women with a diagnosis of lupus who were delivered at our institution over a 101-month period were included in the study. The method of selection of the lupus pregnancies for analysis is shown in the Figure. As indicated, there were 143 pregnancies in 98 women with lupus who were delivered at our institution over the 101-month period (SLE

Results

Results are delineated by the order shown in the Figure, beginning with fetal wastage. In our SLE total group, 82.5% of the pregnancies (118/143) resulted in a live birth, and fetal wastage was 17.5% (25/143 pregnancies). When the SLE TOTAL Group and the SLE first pregnancy group are compared with their respective control groups, there is a reduction of the odds ratio from 6.20 (all pregnancies) to 4.84 (1 pregnancy per parturient) for stillbirths in lupus pregnancies. When stillbirth rates are

Comment

The key finding of our study is that poor fetal outcomes are seen in pregnancies that are complicated by lupus, even before the disease is clinically apparent in the mother. This is a firm conclusion, although we encountered some limitations in our attempt to do a large rigorous study in assessing fetal growth in pregnancies that were complicated by lupus. Unfortunately, we ended up with a smaller sample size than we would have liked, which was necessitated by assuring statistical independence.

Acknowledgment

We thank Dr Sean Blackwell for the compilation and analysis of the control sample data.

References (41)

  • E.C. Tozman et al.

    Systemic lupus erythematosus and pregnancy

    J Rheumatol

    (1980)
  • H. Julkunen et al.

    Fetal outcome in lupus pregnancy: a retrospective case-control study of 242 pregnancies in 112 patients

    Lupus

    (1993)
  • M. Petri et al.

    Fetal outcome of lupus pregnancy: a retrospective case-control study of the Hopkins Lupus Cohort

    J Rheumtol

    (1993)
  • M.L. Gimovsky et al.

    Pregnancy outcome in women with systemic lupus erythematosus

    Obstet Gynecol

    (1984)
  • L.G. Fine et al.

    Systemic lupus erythematosus in pregnancy

    Ann Int Med

    (1981)
  • M. DeBandt et al.

    Outcome of pregnancies in lupus: experience at one center

    Ann Med Interne (Paris)

    (2000)
  • K.R. Johns et al.

    Pregnancy outcome in systemic lupus erythematosus (SLE): a review of 54 cases

    Aust N Z J Med

    (1998)
  • D. Kleinman et al.

    Perinatal outcomes in women with systemic lupus erythematosus

    J Perinatol

    (1998)
  • D. Li Thi Huong et al.

    Epidemiologic study of pregnancy complicated by lupus

    Ann Med Interne (Paris)

    (1990)
  • G. Burkett

    Lupus nephropathy and pregnancy

    Clin Obstet Gynecol

    (1985)
  • Cited by (65)

    • Pregnancy and Kidney Disease

      2019, Chronic Renal Disease
    • Pregnancy outcome of systemic lupus erythematosus in relation to lupus activity before and during pregnancy

      2015, Journal of the Chinese Medical Association
      Citation Excerpt :

      Termination of pregnancy may not be needed if there were neither severe lupus nephropathy nor involvement of central nervous system at the time of conception. Many complications, such as abortion, fetal loss, preterm birth, pregnancy-induced hypertension, preeclampsia superimposed on chronic hypertension, intrauterine fetal distress, and fetal growth restriction make pregnancies with lupus very complicated, especially in those cases who were not well prepared for conception.3–5 However, the correlation between pregnancy outcome and preconceptional lupus activity was still questionable for lack of convincing analysis.

    • Pregnancy and Chronic Kidney Disease

      2015, Chronic Renal Disease
    View all citing articles on Scopus

    Supported by the Lupus Alliance of America, Michigan Indiana Chapter (formerly: Lupus Foundation of Michigan); the Michigan Education and Research Foundation (Blue Cross/Blue Shield of Michigan); the Fraternal Order of Eagles: Roseville, Michigan Chapter.

    View full text