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Epidemiology & Outcomes
609 Pregnancy outcomes in systemic lupus erythematosus (SLE): data from a multiethnic, multinational Latin American cohort
  1. Rosa Maria Serrano Morales1,
  2. Romina Nieto1,
  3. Rosana Quintana1,
  4. Paula Alba2,
  5. Sabrina Porta3,
  6. Lucia Hernández4,
  7. Guillermo Berbotto5,
  8. Verónica Inés Bellomio6,
  9. Nílzio Da Silva7,
  10. Odirlei Monticielo8,
  11. Fernando Cavalcanti9,
  12. Francinne Machado Ribeiro10,
  13. Eduardo Borba11,
  14. Eloisa Bonfa11,
  15. Loreto Massardo12,
  16. Gustavo Aroca Martínez13,
  17. Andrés Cadena Bonfanti13,
  18. Gerardo Quintana Lopez14,
  19. Mario Javier Moreno Alvarez15,
  20. Jorge Antonio Esquivel Valerio16,
  21. Isabel Acosta-Colman17,
  22. Astrid Paats17,
  23. Claudia Mora18,
  24. Marina Scolnik19,
  25. Diana Fernández Ávila19,
  26. Carmen Funes Soaje20,
  27. Veronica Saurit21,
  28. Mercedes García22,
  29. Eduardo Kerzberg23,
  30. Graciela Gomez24,
  31. Cecilia Pisoni25,
  32. Edgard Reis Neto26,
  33. Iris Guerra Herrera27,
  34. Oscar Neira27,
  35. Carlos Cañas28,
  36. Miguel A Saavedra29,
  37. Margarita Portela30,
  38. Hilda Fragoso Loyo31,
  39. Luis Humberto Silveira Torre32,
  40. Ignacio Garcia-De La Torre33,
  41. Manuel F Ugarte-Gil34,
  42. Armando Calvo Quiroz35,
  43. Roberto Muñoz Louis36,
  44. Ricardo Robaina37,
  45. Vicente Juarez38,
  46. Alvaro Danza39,
  47. Carlos Enrique Toro Gutierrez40,
  48. Carlos Abud-Mendoza41,
  49. Ana Malvar42,
  50. Graciela S Alarcon43,
  51. Ashley Orillion44,
  52. Urbano Sbarigia45,
  53. Anne Stevens44,
  54. Federico Zazzetti46,
  55. Guillermo Pons-Estel1 and
  56. Bernardo Pons-Estel1
  1. 1Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR)., Rosario, Argentina
  2. 2Hospital Córdoba, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba., Córdoba, Argentina
  3. 3Hospital General de Agudos, Carlos G. Durand, Rheumatology Department, CABA, Buenos Aires, Argentina
  4. 4GLADEL, statistician, Rosario, Argentina
  5. 5Hospital Escuela ‘Eva Perón’, Servicio de Reumatología, Granadero Baigorria, Argentina
  6. 6Hospital Padilla, Servicio de Reumatología, San Miguel de Tucumán, Argentina
  7. 7Hospital das Clínicas, Universidad Federal de Goias, Goias, Brazil
  8. 8Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rheumatology Division, Department of Internal Medicine, Porto Alegre, Brazil
  9. 9Centro de Ciencias Médicas, Hospital das Clínicas, Universidade Federal de Pernambuco., Servicio de Reumatología, Departamento de Medicina Clínica., Pernambuco, Brazil
  10. 10Hospital Universitario Pedro Ernesto, Universidade do Estado do Rio de Janeiro., Rheumatology Division., Rio de Janeiro, Brazil
  11. 11Hospital das Clinicas. HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rheumatology Division., Sao Paulo, Brazil
  12. 12Universidad San Sebastián., Facultad de Medicina y Ciencia., Santiago de Chile, Chile
  13. 13Clínica de la Costa., Universidad Simón Bolívar., Barranquilla, Colombia
  14. 14Fundación Santa Fe de Bogotá, University Hospital. Universidad de los Andes. Universidad Nacional de Colombia., REUMAVANCE Group, Rheumatology Section, Department of Internal Medicine. School of Medicine, Bogotá, Colombia
  15. 15Hospital ‘Luis Vernaza’, Universidad de Especialidades Espíritu Santo., Servicio de Reumatología., Guayaquil, Ecuador
  16. 16Hospital Universitario ‘Dr, José Eleuterio González’, Universidad Autónoma de Nuevo León, Servicio de Reumatología, Monterrey, Mexico
  17. 17Facultad de Ciencias Medicas, Universidad Nacional de Asunción, Departamento de Reumatología, Asunción, Paraguay
  18. 18Hospital Nacional ‘Edgardo Rebagliati Martins’., Servicio de Reumatología, Departamento de Especialidades Médicas., Lima, Peru
  19. 19Hospital Italiano de Buenos Aires, Rheumatology Section, Buenos Aires, Argentina
  20. 20Hospital Italiano de Córdoba, Servicio de Reumatología, Córdoba, Argentina
  21. 21Hospital Privado Universitario de Córdoba, Servicio de Reumatología, Córdoba, Argentina
  22. 22HIGA San Martin de La Plata, Servicio de Reumatología, La Plata, Argentina
  23. 23Hospital ‘José María Ramos Mejía’, Rheumatology Department, Buenos Aires, Argentina
  24. 24Instituto de Investigaciones Médicas ‘Alfredo Lanari’, Universidad de Buenos Aires, Departamento de Inmunología, Buenos Aires, Argentina
  25. 25Centro De Educación Médica e Investigaciones Clínicas ‘Norberto Quirno’ (CEMIC), Sección de Reumatología e Inmunología, Buenos Aires, Argentina
  26. 26Universidade Federal de Sao Paulo, Escola Paulista de Medicina, Sao Paulo, Brazil
  27. 27Hospital del Salvador, Universidad de Chile, Sección de Reumatología, Santiago de Chile, Chile
  28. 28Fundación Valle del Lili, Servicio de Reumatología, Cali, Colombia
  29. 29Hospital de Especialidades, Centro Médico Nacional La Raza, Servicio de Reumatología, Ciudad de México, Mexico
  30. 30Centro Médico Nacional Siglo XXI, Departamento de Reumatología, Ciudad de México, Mexico
  31. 31Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Inmunología y Reumatología, Ciudad de México, Mexico
  32. 32Instituto Nacional de Cardiología Ignacio Chávez, Departamento de Reumatología, Ciudad de México, Mexico
  33. 33Hospital General de Occidente, Universidad de Guadalajara., Departamento de Inmunología y Reumatología, Zapopan, Mexico
  34. 34Hospital Nacional ‘Guillermo Almenara Irigoyen’, EsSalud. Universidad Científica del Sur., Servicio de Reumatología, Lima, Peru
  35. 35Hospital Nacional ‘Cayetano Heredia’, Servicio de Reumatología, Lima, Peru
  36. 36Hospital Docente ‘Padre Bellini’, Servicio de Reumatología, Santo Domingo, Dominican Republic
  37. 37Hospital de Clínicas, Facultad de Medicina, Universidad de la República., Unidad de Enfermedades Autoinmunes Sistémicas, Montevideo, Uruguay
  38. 38Hospital Señor del Milagro, Servicio de Reumatología, Salta, Argentina
  39. 39Corporación de Asistencia Médica (MUCAM) and Clínica Médica. Universidad de la República., Unidad de Enfermedades Autoinmunes de Médica Uruguaya. Facultad de Medicina, Montevideo, Uruguay
  40. 40Centro de Estudios de Reumatología and Dermatología SAS, Cali, Colombia
  41. 41Hospital Central ‘Dr. Ignacio Morones Prieto’, y Facultad de Medicina, Universidad Autónoma de San Luis Potosí, Unidad Regional de Reumatología, San Luis Potosí, Mexico
  42. 42Hospital General de Agudos Dr. Juan A. Fernández, Nefrología, Buenos Aires, Argentina
  43. 43The University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, USA
  44. 44Janssen Pharmaceutical Companies of Johnson and Johnson, Janssen Research and Development, Spring House, USA
  45. 45Janssen Pharmaceutical Companies of Johnson and Johnson, Janssen Pharmaceutical NV, Beerse, Belgium
  46. 46Janssen Pharmaceutical Companies of Johnson and Johnson, Pharmaceutical Company, Horsham, USA

Abstract

Background Obstetric morbidity (OM) is higher in SLE women than in healthy ones. Few data on SLE pregnancy outcomes in Latin America (LA) have been reported.

Objectives To study SLE pregnancy outcomes in LA.

Methods GLADEL 2.0 is an observational prevalent/incident cohort started in 2019. To date, 43 centers from 10 LA countries have enrolled 1030 SLE patients (1982/1997 ACR or SLICC criteria). Women with ≥1 pregnancy were included. Past and ongoing (6, 12, 24 months follow-up) OM (miscarriages, fetal deaths, preeclampsia, 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. Preeclampsia 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 (no cardiac involvement). Antiphospholipid syndrome (APS) was associated with higher risk of OM (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 singles pregnancies occurred. All were 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 preeclampsia. One cholestasis gravidarum (4.2%) lead to prematurity. There were no new cases of neonatal lupus.

Conclusion In GLADEL 2.0 cohort, around half of the studied women presented OM being frequently related to APS. Miscarriages, prematurity, preeclampsia and fetal deaths were the most common pregnancy complications. The incidence of neonatal lupus was lower than previously reported.1

Reference

  1. Cimaz R, et al. 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.

Lay summary Pregnancy in patients with lupus carries increased risk to both the mother and baby. Black and Hispanic patients are the most seriously affected, but pregnancy in lupus is not well understood in Latin American patients. Results from a multiethnic, multinational Latin American cohort of patients with lupus showed that miscarriages, prematurity, preeclampsia, and fetal deaths were the most common pregnancy complications. The results of this study highlight the great unmet need in improved care of patients with lupus during pregnancy to protect the health of the mother and baby.

View this table:
Abstract 609 Table 1

Characteristics of SLE women with ≥1 pregnancy at cohort inclusion related to OM1

Abstract 609 Figure 1
Abstract 609 Figure 1

SLE pregnancy outcome 2-year follow-up

Disclosure of interest Rosa Maria Serrano Morales: None declared, Romina Nieto: None declared, Rosana Quintana: None declared, Paula Alba: None declared, Sabrina POrta: None declared, Lucia Hernández: None declared, Guillermo Berbotto: None declared, Verónica Inés Bellomio: None declared, Nílzio da Silva: None declared, Odirlei Monticielo: None declared, Fernando Cavalcanti: None declared, Francinne Machado Ribeiro: None declared, Eduardo Borba: None declared, Eloisa Bonfa: None declared, loreto massardo: None declared, Gustavo Aroca Martínez: None declared, Andrés Cadena Bonfanti: None declared, GERARDO QUINTANA LOPEZ: None declared, Mario Javier MORENO ALVAREZ: None declared, Jorge Antonio Esquivel Valerio: None declared, Isabel Acosta-Colman: None declared, Astrid Paats: None declared, CLAUDIA MORA: None declared, Marina Scolnik: None declared, Diana Fernández Ávila: None declared, Carmen Funes Soaje: None declared, Veronica Saurit: None declared, Mercedes García: None declared, Eduardo Kerzberg: None declared, Graciela Gomez: None declared, Cecilia Pisoni: None declared, Edgard Reis Neto: None declared, Iris Guerra Herrera: None declared, Oscar Neira: None declared, Carlos Cañas: None declared, Miguel A Saavedra: None declared, Margarita Portela: None declared, Hilda Fragoso loyo: None declared, Luis Humberto Silveira Torre: None declared, Ignacio Garcia-De La Torre: None declared, Manuel F. Ugarte-Gil: None declared, Armando Calvo Quiroz: None declared, Roberto Muñoz Louis: None declared, RICARDO ROBAINA: None declared, Vicente Juarez: None declared, ALVARO DANZA: None declared, Carlos Enrique Toro Gutierrez: None declared, Carlos Abud- Mendoza: None declared, Ana Malvar: None declared, Graciela S Alarcon: None declared, Ashley Orillion Shareholder of: Janssen Research & Development, Spring House, USA, Speakers bureau: Janssen Research & Development, Spring House, USA, Paid instructor for: Janssen Research & Development, Spring House, USA, Consultant of: Janssen Research & Development, Spring House, USA, Grant/research support from: Janssen Research & Development, Spring House, USA, Employee of: Janssen Research & Development, Spring House, USA, Urbano Sbarigia Shareholder of: Janssen Pharmaceutica NV, Beerse, Belgium, Speakers bureau: Janssen Pharmaceutica NV, Beerse, Belgium, Paid instructor for: Janssen Pharmaceutica NV, Beerse, Belgium, Consultant of: Janssen Pharmaceutica NV, Beerse, Belgium, Grant/research support from: Janssen Pharmaceutica NV, Beerse, Belgium, Employee of: Janssen Pharmaceutica NV, Beerse, Belgium, Federico Zazzetti Shareholder of: Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA;, Speakers bureau: Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA;, Paid instructor for: Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA;, Consultant of: Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA;, Grant/research support from: Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA;, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA;, Guillermo Pons-Estel: None declared, Bernardo Pons-Estel: None declared. Johnson, Horsham, PA, USA;, Guillermo Pons-Estel: None declared, Bernardo Pons-Estel: None declared. Johnson, Horsham, PA, USA;, Guillermo Pons-Estel: None declared, Bernardo Pons-Estel: None declared.

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/lupus-2023-lupus21century.40

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