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Abstract
Objective Lupus pregnancies are considered as high risk because of both disease activation and pregnancy complications. In this study, we determined the risk factors associated with adverse pregnancy outcomes (APO) in pregnant patients with lupus followed up by both Rheumatology and Obstetrics and Gynaecology (O&G) departments at our university.
Method 136 lupus patients with 168 pregnancies were analyzed. The course of pregnancies and fetal/neonatal prognosis were identified. Unexplained fetal death ≥12 gestational weeks, neonatal death, preeclampsia, eclampsia, preterm birth due to HELLP and/or small for gestational age (SGA) infant were defined as APO. Clinical and laboratory findings, disease activity (SLEDAI-2K) and damage (SLICC/ACR) and conventional risk factors were compared between APO (+) and APO (-) groups.
Results 71% of pregnancies resulted in live births and APOs occurred in 34% (table 1). Renal and neuropsychiatric (NP) involvement, thrombocytopenia, antiphospholipid syndrome (APS), lupus anticoagulant and anti-cardiolipin IgM positivity rates were significantly higher in APO (+) (table 2). Mean SLEDAI-2K during pregnancy and postpartum were higher in APO (+) (2.2 ± 3.6 vs 1.2 ± 2.04, p <0.05; 4.9 ± 6.03 vs 2.7 ± 5.01, p=0.02, respectively). There were significantly more patients with damage in the APO(+) and their mean damage score was significantly higher (1.8 ± 2.1 vs 0.8 ± 1.3, p <0.05). The frequency of patients with NP, renal, cardiovascular and musculoskeletal damage was significantly higher in the APO(+) (figure 1).
Pregnancy (n=168), fetal and neonatal outcomes in SLE pregnancy cohort (n=136)
Demographic data of APO (+) and APO (-) groups, comparison of conventional risk factors, cumulative clinical, serological and laboratory features
Distribution of damage according to organs/systems among APO (+) and APO (-) groups
Conclusion Although an important proportion of SLE pregnancies result in live birth, active disease, especially renal and NP involvement, and damage increase the risk of complications. Furthermore, the presence of APS or antiphospholipid antibody positivity are important risk factors for APO. In conclusion, patients, especially with damage, should be pre-counselled to be made aware of the risks. Pregnancy should be allowed after disease activity is controlled and a close monitoring with O&G clinics is essential.