Can pregnancy induce relapse in systemic lupus erythematosus (SLE)?

Parastandechehr, Gilda; Faezi, Seyedeh Tahereh; Paragomi, Pedram; Akhlaghi, Maassoumeh; Akbarian, M.

doi:10.22631/rr.2016.40681

Cited by 3 publications

(7 citation statements)

References 33 publications

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“…In the previous studies, abortion has been one of the most common pregnancy outcomes in women with SLE. This complication in study of Yuen et al [10] and Parastandechehr et al [11] were reported 19.5% and 19%, respectively. Clowse and colleagues were founded that the activity of SLE during pregnancy led to a threefold increase in spontaneous abortion [12].…”

Section: Discussionmentioning

confidence: 83%

“…Disease activity was estimated based on the systemic lupus erythematosus disease activity index (SLEDAI). Patients were categorized into three groups, according to SLEDAI score: remission (6>), mild to moderate activity [6][7][8][9][10][11][12] and high activity (>12). The medical records of patients were comprehensively reviewed to collect demographic, clinical and laboratory data.…”

Section: Methodsmentioning

confidence: 99%

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The study of factors associated with pregnancy outcomes in patients with systemic lupus erythematosus

et al. 2020

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Objectives: Systemic lupus erythematosus (SLE) is an autoimmune disease that can lead to unfavorable pregnancy complications in women. This study aimed to evaluate the factors associated with pregnancy outcomes in patients with SLE. Results: Fifty-nine pregnant women with SLE (121 pregnancies) participated in this retrospective cohort study. The mean age of the patients was 33.74 ± 3.80 years (range 21 to 48 years). Fetal loss occurred in 43.8% of pregnancies. The most common laboratory findings in SLE patients were antinuclear antibody (81.4%) and anti-ds DNA positivity (54.2%). High levels of C-reactive protein (CRP) during pregnancy, renal involvement, anti-double-stranded DNA positivity, anti-phospholipid antibody (APA) positivity and younger age at disease onset were significantly correlated with unfavourable pregnancy outcomes. A significant difference was observed between duration of SLE and low birth weight (P = 0.003), pre-eclampsia (P = 0.012) and still birth (P = 0.036). High CRP, APA positivity, anti-dsDNA positivity and kidney involvement were predictors of adverse pregnancy outcomes in SLE patients. Renal involvement increased risk of pregnancy with complication 8.5 times (OR = 8.5, 95% CI 1.396-63.373, P = 0.017). Antiphospholipid syndrome (APS) also was associated with an odds ratio of 5.18 (95% CI 1.681-13.647, P = 0.001).

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Section: Discussionmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

The study of factors associated with pregnancy outcomes in patients with systemic lupus erythematosus

et al. 2020

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“…During lupus pregnancies, there is an increased risk of maternal and fetal morbidity and mortality, but a stable disease prior to conception can act as predictor of a good outcome [38]. The onset of new symptoms or signs as arthritis, discoid or subacute cutaneous lupus lesions, oral ulcers, vasculitis, polyserositis, lymphadenopathy, positive direct Coombs, myocarditis, pneumonitis, proteinuria, leucopenia, thrombocytopenia, complement consumption or raised anti-DNA antibody expression must arise the suspicion about an ongoing lupus flare [12,38].…”

Section: Lupus Flarementioning

confidence: 99%

“…During a healthy pregnancy, complement levels are usually raised, as it acts as acute phase reactant [31]. So, normal or lower range of complement suggests serum consumption due inflammatory process [38]. The coexistence of hypocomplementemia and high SLE activity usually predicts a poor pregnancy outcome.…”

Section: Lupus Flarementioning

confidence: 99%

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Systemic Lupus Erythematosus Pregnancy

Fernandes¹,

Bernardino²,

Taulaigo³

et al. 2021

Lupus - Need to Know

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Systemic Lupus Erythematosus (SLE) is an autoimmune disease of unknown etiology that often affects women during childbearing age. Pregnant women with SLE are considered high-risk patients, with pregnancy outcomes being complicated by high maternal and fetal mortality and morbidity. Obstetric morbidity includes preterm birth, fetal growth restriction (FGR), and neonatal lupus syndromes. Active SLE during conception is a strong predictor of adverse pregnancy outcomes and exacerbations of disease can occur more frequently during gestation. Therefore, management of maternal SLE should include preventive strategies to minimize disease activity and to reduce adverse pregnancy outcomes. Patients with active disease at time of conception have increased risk of flares, like lupus nephritis, imposing a careful differential diagnosis of pre-eclampsia, keeping in mind that physiological changes of pregnancy may mimic a lupus flare. Major complications arise when anti-phospholipid antibodies are present, like recurrent pregnancy loss, stillbirth, FGR, and thrombosis in the mother. A multidisciplinary approach is hence crucial and should be initiated to all women with SLE at childbearing age with an adequate preconception counseling with assessment of risk factors for adverse maternal and fetal outcomes with a tight pregnancy monitoring plan. Although treatment choices are limited during pregnancy, prophylactic anti-aggregation and anticoagulation agents have proven beneficial in reducing thrombotic events and pre-eclampsia related morbidity. Pharmacological therapy should be tailored, allowing better outcomes for both the mother and the baby. Immunosuppressive and immunomodulators, must be effective in controlling disease activity and safe during pregnancy. Hydroxychloroquine is the main therapy for SLE due to its anti-inflammatory and immunomodulatory effects recommended before and during pregnancy and other immunosuppressive drugs (e.g. azathioprine and calcineurin inhibitors) are used to control disease activity in order to improve obstetrical outcomes. Managing a maternal SLE is a challenging task, but an early approach with multidisciplinary team with close monitoring is essential and can improve maternal and fetal outcomes.

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Factors associated with adverse pregnancy outcomes in patients with systemic lupus erythematosus

Santos

Morales

Castro

et al. 2022

Musculoskeletal Care

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Background: Pregnancies in Systemic lupus erythematosus (SLE) are considered high risk and associated with maternal and obstetric complications. Objectives: To determine the most important predictors for each of the main adverse pregnancy outcomes in SLE patients. Methods: Patients with SLE were retrospectively analysed from 1990 to 2020. Maternal and fetal complications in pregnant women with SLE were retrieved. We compared clinical and analytical characteristics of SLE patients with adverse pregnancy outcomes to controls with SLE diagnosis without adverse pregnancy outcomes. Qualitative data were analysed by Chi-square test and Fisher's exact test. Continuous variables were analysed by using Student's t test. Multiple logistic regression was performed to determine the predictive factors for adverse pregnancy outcomes with adjustment of confounding factors. Results: 135 multiparous women were included (42% with adverse pregnancy outcomes). A total of 57 pregnancies (42%) were linked to adverse outcomes. The occurrence of abortion was correlated with anti-DNAds (β = 0.71, p = 0.04), renal involvement (β = 0.28, p 0.03), antiphospholipid antibodies (APA) (β = 0.29, p 0.03), erythrocyte sedimentation rate (ESR) elevation (β = 0.81, p = 0.02) and C-reactive protein (CPR) elevation (β = 0.91, p = 0.01). Stillbirth was also correlated with renal involvement (β = 0.26, p = 0.04), APA (β = 0.22, p = 0.03) and ESR elevation (β = 0.53, p = 0.02). Preeclampsia was correlated with direct Coombs positivity (β = 0.42, p = 0.01), serositis (β = 0.31, p = 0.02), ESR elevation (β = 0.52, p = 0.03) and CPR elevation (β = 0.32, p = 0.04). Neonatal Lupus was correlated with anti-RNP (β = 0.16, p = 0.03) and anti-Ro/SSA (β = 0.16, p 0.02). Conclusions:The most unfavourable pregnancy outcome in women with SLE was spontaneous abortion. Renal involvement, anti-DNAds positivity, antiphospholipid antibody positivity, anti-Ro/SSA, elevated ESR and a younger age at disease onset increased the risk of pregnancy complications.

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Can pregnancy induce relapse in systemic lupus erythematosus (SLE)?

Cited by 3 publications

References 33 publications

The study of factors associated with pregnancy outcomes in patients with systemic lupus erythematosus

The study of factors associated with pregnancy outcomes in patients with systemic lupus erythematosus

Systemic Lupus Erythematosus Pregnancy

Factors associated with adverse pregnancy outcomes in patients with systemic lupus erythematosus

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