Background Obstetric morbidity (OM) is higher in Systemic Lupus Erythematosus (SLE) women than in healthy ones. Few data on SLE pregnancy outcomes in Latin America (LA) have been reported. The aim of this study was to assess SLE pregnancy outcomes in LA.
Methods GLADEL 2.0 is an observational prevalent/incident cohort started in 2019.1 To date, 43 centers from 10 LA countries have enrolled 1030 SLE patients, ≥18 years, 1982/1997 ACR or SLICC criteria. Women with at least one pregnancy were included. Past and ongoing (6, 12, 24 months follow-up) OM (miscarriages, fetal deaths, pre-eclampsia, prematurity, neonatal lupus) were evaluated.
Results At inclusion, 329 women have had at least one pregnancy [median (IQR): 2 (1–3)]: table 1. Of them, 293 (89.1%) had ≥1 live birth and 183 (55.6%) developed OM. Pre-eclampsia occurred in 49 (14.9%). Among 71 (21.6%) women with anti-SS-A(Ro)/SS-B(La) antibodies, 3 (4.2%) developed neonatal lupus (without cardiac involvement). Anti-phospholipid syndrome (APS) was associated with a higher risk of pregnancy complications (52.2% vs 10.0%; p< 0.001). Of the 755 pregnancies reported, 551 (73.0%) resulted in live births, of which 79 (14.3%) were premature. The remaining pregnancies ended in 178 (23.6%) miscarriages and 41 (5.4%) fetal deaths. During 2-follow-up years (figure 1), 24 single pregnancies occurred. All occurred under antimalarials; 16 (66.7%) resulted in live births, 4 (25.0%) premature; 12 (50.0%) developed OM. There were seven (29.2%) miscarriages and one fetal loss (4.2%) related to severe pre-eclampsia. One cholestasis gravidarum (4.2%) lead to prematurity. New cases of neonatal lupus were not reported.
Conclusions In GLADEL 2.0 cohort, around half of the women studied presented OM, being frequently related to APS. Miscarriages, prematurity, pre-eclampsia, and fetal deaths were the most common fetal-maternal complications. The incidence of neonatal lupus was lower than previously reported (16%).2
A longitudinal multiethnic study of biomarkers in systemic lupus erythematosus: Launching the GLADEL 2.0 Study Group. Gómez-Puerta JA, Pons-Estel GJ, Quintana R, Nieto R, Serrano Morales RM, Harvey GB, Wojdyla D, Scolnik M, Funes Soaje C, Alba Moreyra P, Novatti E, Arizpe F, Berbotto GA, González Lucero L, Porta S, Pérez N, Rodriguez AM, Appenzeller S, de Oliveira E Silva Montadon AC, Monticielo OA, Cavalcanti FS, Machado Ribeiro F, Borba EF, Torres Dos Reis-Neto E, Neira O, Chahuán JM, Mimica M, Aroca Martínez G, Tobón GJ, Vásquez G, Quintana-Lopez G, Moreno Alvarez MJ, Saavedra MÁ, Cristobal MP, Fragoso-Loyo H, Amezcua-Guerra LM, González-Bello YC, Abud-Mendoza C, Esquivel-Valerio JA, Duarte M, Acosta Colman I, Mora-Trujillo C, Reátegui-Sokolova C, Calvo Quiroz AA, Muñoz-Louis R, Cairoli E, Rosas I, Rebella M, Cardiel MH, García de la Torre I, Catoggio LJ, Alarcón GS, Pons-Estel BA. Lupus. 2021 Jan 28:961203320988586.
Cimaz R, Spence DL, Hornberger L, Silverman ED. Incidence and spectrum of neonatal lupus erythematosus: a prospective study of infants born to mothers with anti-Ro autoantibodies. J Pediatr 2003;142:678–83.
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