Abstract
Background Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects women in childbearing age, so its association with pregnancy is not a rare event. With the analysis of our cohort over the past 10 years, we seek to clarify the clinical characteristics, evolution, impact of the treatment and evaluation of the outcomes of those pregnancies in our institution.
Methods Retrospective descriptive study of all SLE pregnancies supervised in the Autoimmune Disorders and Pregnancy Consultation Unit of our center, from January 2009 to October 2019.
Results 120 pregnancies were included in 91 patients with a mean age of 32.0 years. 36.0% were primiparous and 26.8% had history of miscarriage. In 31.2% of cases, SLE was associated with other autoimmune diseases and in 14.1% it was associated with anti-phospholipid antibody syndrome. 11.7% of patients had history of renal involvement. 95% of all pregnant women continued the previous medication during pregnancy.
Hydroxychloroquine was the most commonly used drug (58.3% of cases). 14.2% had clinical or analytical worsening during the course of pregnancy and 11.9% at postpartum and all of those cases were controlled with adjustment of the medication. 17.0% of cases had a preterm delivery, of which 53.8% were iatrogenic preterm deliveries. There was an incidence of pre-eclampsia of 11.9% and 10.7% of the pregnancies were complicated by fetal growth restriction. The percentage of caesarean delivery was 40.5%. 10.7% of neonates had criteria of neonatal lupus, and there was one case of congenital complete heart block, which required a neonatal cardiac pacemaker. There were no cases of neonatal deaths or asphyxia.
Conclusions In SLE pregnant patients, to ensure the best maternal and fetal outcomes, it is crucial that the pregnancy occurs in a period of immunological stability as well as an adequate surveillance by a multidisciplinary team prepared to control all the complications that may arise.
