A national study of the complications of lupus in pregnancy

Clowse, Megan E.B.; Jamison, Margaret G.; Myers, Evan R.; James, Andra H.

doi:10.1016/j.ajog.2008.03.012

Cited by 516 publications

(402 citation statements)

References 20 publications

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“…According to the literature, one third of pregnancies will result in a cesarean section, 33% will have preterm birth, and more than 20% will be complicated by preeclampsia [3,4,12,16]. Pregnancy outcome in SLE and the risks for these complications relate to lupus activity, antiphospholipid antibodies, renal status, hypertension, and medication complications [4,10,13,15].…”

Section: Discussionmentioning

confidence: 99%

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Lupus and Pregnancy—15 Years of Experience in a Tertiary Center

Ambrósio¹,

Lermann²,

Cordeiro³

et al. 2009

Clinic Rev Allerg Immunol

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This retrospective study was designed to evaluate the outcome of pregnancies in women diagnosed with systemic lupus erythematosus (SLE) followed in a tertiary fetal-maternal center. Data were collected from clinical charts between January 1993 and December 2007, with a total of 136 pregnancies (107 patients). Mean maternal age was 29 years, with the vast majority of patients being Caucasian. Most patients were in remission 6 months prior to pregnancy (93%) and the most frequently affected organs were the skin and joints. Renal lupus accounted for 14% of all cases. Twenty-nine percent of patients were positive for at least one antiphospholid antibody (aPL) and nearly 50% had positive SSa/SSb antibodies. All patients with positive aPL received low-dosage aspirin and lowmolecular-weight heparin (LMWH). There were no pregnancy complications in more than 50% of cases and hypertensive disease and intrauterine growth restriction were the most common adverse events. There were 125 live births, one neonatal death, eight miscarriages, and three medical terminations of pregnancy. Preterm delivery occurred in 25% of pregnancies. Our results are probably the conjoined result of a multidisciplinary approach together with a systematic management of SLE pregnancies, with most patients keeping their prior SLE medication combined with low-dosage aspirin and LMWH in the presence of aPL.

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Section: Discussionmentioning

confidence: 99%

“…Many of these complications can be attributed to SLE treatment more than to the disease itself. Several factors are believed to influence the outcome of pregnancy, namely lupus activity, antiphospholipid antibodies, renal status, hypertension and medication complications [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Lupus and Pregnancy—15 Years of Experience in a Tertiary Center

Ambrósio¹,

Lermann²,

Cordeiro³

et al. 2009

Clinic Rev Allerg Immunol

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“…Several studies have demonstrated individual medical comorbidities, such as pre-existing asthma, hypertension, malignancy, chronic ischaemic and congenital heart disease, chronic renal disease, systemic lupus erythematosus, hypercoagulability states, human immunodeficiency virus and diabetes mellitus, to be associated with both severe maternal morbidity and mortality, 25,153,[162][163][164][165][166][167][168] but the extent of the population risk attributable to medical comorbidities as a whole in the UK has not previously been quantified. Uptake of antenatal care was found to be poorer among women with medical comorbidities in our study population, which could increase the adverse effects associated with these conditions.…”

Section: Conclusion and Implications For Policy And Practicementioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Adverse pregnancy outcomes have been reported in mothers with systemic lupus erythematosus (SLE) and their offspring 1, 2, 3. These include preeclampsia, preterm birth, stroke, and even death.…”

Section: Introductionmentioning

confidence: 99%

What to Expect When Expecting With Systemic Lupus Erythematosus (SLE): A Population‐Based Study of Maternal and Fetal Outcomes in SLE and Pre‐SLE

Arkema

Palmsten

Sjöwall

et al. 2016

Arthritis Care & Research

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ObjectiveTo assess maternal and fetal outcomes associated with subclinical (pre‐systemic lupus erythematosus [SLE] and SLE presenting up to 5 years postpartum) and prevalent maternal SLE during pregnancy compared with the general population.MethodsThis prospective cohort study used population‐based Swedish registers to identify 13,598 women with first singleton pregnancies registered in the Medical Birth Register (551 prevalent SLE, 65 pre‐SLE within 0–2 years, 133 pre‐SLE within 2–5 years, and 12,847 general population). SLE was defined as ≥2 SLE‐coded discharge diagnoses in the patient register with ≥1 diagnosis from a specialist. Unadjusted risks of adverse pregnancy or birth outcomes were calculated by SLE status, and Cochran‐Armitage tests evaluated trend across exposure groups.ResultsMaternal outcomes such as preeclampsia, hypothyroidism, stroke, and infection were more common among women with SLE. Sixteen percent of prevalent‐SLE pregnancies were diagnosed with preeclampsia compared with 5% of those from the general population. Among the pre‐SLE women, preeclampsia was found in 26% of those with SLE within 2 years postpartum and 13% in those with SLE within 2–5 years postpartum. Similarly, infant outcomes, such as preterm birth, infection, and mortality, were worse among those born to mothers with prevalent SLE and pre‐SLE during pregnancy. The test for trend was significant for most outcomes.ConclusionOur data demonstrate that adverse maternal and fetal outcomes are more common in SLE pregnancies. Furthermore, these unfavorable outcomes are observed in pregnancies occurring prior to the diagnosis of SLE. Thus, the underlying immunologic profile of SLE and alterations preceding clinical SLE may contribute to these pregnancy complications.

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A national study of the complications of lupus in pregnancy

Cited by 516 publications

References 20 publications

Lupus and Pregnancy—15 Years of Experience in a Tertiary Center

Lupus and Pregnancy—15 Years of Experience in a Tertiary Center

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

What to Expect When Expecting With Systemic Lupus Erythematosus (SLE): A Population‐Based Study of Maternal and Fetal Outcomes in SLE and Pre‐SLE

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