Background/Purpose Most reports show an increased Systemic Lupus Erythematosus (SLE) activity during pregnancy and worse maternal-fetal outcomes than those of the general population. The objective of this work is to describe pregnancy outcomes of Uruguayan women with SLE.
Materials and Methods We performed a prospective study of a SLE pregnant cohort. All patients were evaluated and followed with the same clinical protocol in a multidisciplinary care unit (internal medicine, gynecology, hematology, nephrology) from January 2008 to December 2018. Clinical and laboratory data were collected in a preformed clinical record registry.
Results Seventy pregnancy (67-women) with a medium age of 26 (16–41) years old were included. Before pregnancy SLE involvement was: cutaneous (75%), joint (65%), hematological (41%) and renal (40%) (Type -WHO- I:2/II:9/III:3/IV:5/V:9). Eleven patients had carried out a preconception counselling. Median time between SLE onset and pregnancy was 6 (1–25) years. At the beginning of the follow-up, disease was active in 15,7% and status of antibodies was: persistently positive antiphospholipid: 32.8%, anti-SSA/Ro: 24%, anti-SSB/La: 10%. Mycophenolate, enalapril and warfarin treatment was suspended at the first visit. During pregnancy treatment included: corticosteroids (63%), azathioprine (43%), hydroxychloroquine (97%), low-molecular-weight-heparin (48%) and low-dose aspirin (74%). Thirty-two patients had SLE-flare and 19 (27%) preeclampsia. Preterm delivery (PD) was 42.9%. SLE-flare during pregnancy was associated with PD (p=0.00) and preeclampsia (p=0.04). Lupus nephritis (regardless of activity) was associated with PD (p =0.00) and preeclampsia (p =0.03). Forty-five women had a cesarean section and 37% of them were admitted with preterm labor. Median gestational age at birth was 37±5 weeks and median birth weight was 2770 (710–4315) gr. There were two fetal deaths, two abortions and no maternal deaths.
Conclusion We present the first report of pregnancy outcomes of lupus patients in Uruguay. We highlight the low rate of complications, fetal and maternal death. It is possible that close, protocolized and multidisciplinary follow-up have a positive influence in these good results.
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