Purpose to identify preconception risk factors and serum biomarkers associated with adverse pregnancy outcomes (APOs) in patients with systemic lupus erythematosus (SLE) and primary Sjögren’s syndrome (pSS).
Methods a single-center, retrospective cohort study was conducted, which included pregnant women administered at University Medical Center Groningen between January 2010 and August 2021 who fulfilled the criteria for SLE or pSS. Demographic data, relevant comorbidities, disease duration, disease activity during pregnancy, APOs, laboratory parameters and treatment regimens used up to twelve months before conception were recorded. The associations between the presence of APOs and baseline (preconception) characteristics were evaluated with a univariate Generalized Estimating Equations (GEE) logistic binary model.
Results Our population included 48 (70%) SLE and 21 (30%) pSS pregnancies concerning 70 foetuses (one twin). Included pregnancies led to 37 live births in the SLE group and 18 in the pSS. The mean maternal age was 30.3 and 30.2 years in the SLE and pSS groups, respectively. APOs rates are described in table 1. There was a higher APOs rate in SLE pregnancies (65%) than in pSS (38%). Preterm birth (n = 9, 19%) and intrauterine fetal death (IUFD) (n = 8, 17%) were the most frequent APOs in SLE pregnancies, while in pSS pregnancies this was IUFD (n = 3, 14%). Furthermore, a higher rate of premature rupture of membranes (PROM), preterm birth and hypertensive disorders of pregnancy was observed in SLE pregnancies compared with pSS. Hydroxychloroquine (HCQ) was the most used therapy before conception in the SLE (n = 33, 69%), and the pSS (n= 8, 38%) groups. There were no associations between clinical parameters, laboratory measures, medication use prior to conception, and the presence of APOs in SLE pregnancies. Moreover, there were no significant associations with the presence of combined maternal and neonatal APOs. In the pSS group, significant associations between BMI (p=0.010), parity (p=0.046), C4 (p=0.021), low C4 levels (p=0.002) and presence of APOs were found. Complement levels before pregnancy in pSS patients are shown in figure 1.
Conclusions Systemic autoimmune diseases such as SLE and pSS lead to an increased risk of APOs. Interestingly, SLE pregnancies had higher rates of APOs than pSS pregnancies. In SLE pregnancies, no preconception biomarkers related to the presence of APOs could be determined. Instead, monitoring preconception complement levels could be useful to estimate APOs risk in pSS patients.
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