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

Abstract

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.

Pregnancies in patients with systemic lupus erythematosus during 2000–2018 in Finland: a case–control study

“…Therefore, many potential threats exist regarding family planning. Of particular concern is active disease, especially renal manifestations, during pregnancy [ 1 , 2 ]. Results from earlier studies demonstrate a strong association between antiphospholipids and incidence of thrombotic events and an adverse course of pregnancy [ 2 – 4 ], while SSA and SSB antibodies seem to predispose foetus to congenital cardiac conduction defects quite rarely, in 1–2% of the cases [ 5 – 7 ].…”

“…Of particular concern is active disease, especially renal manifestations, during pregnancy [ 1 , 2 ]. Results from earlier studies demonstrate a strong association between antiphospholipids and incidence of thrombotic events and an adverse course of pregnancy [ 2 – 4 ], while SSA and SSB antibodies seem to predispose foetus to congenital cardiac conduction defects quite rarely, in 1–2% of the cases [ 5 – 7 ]. As a general practice, it is recommended that in every SLE patient risk factors affecting pregnancy should be individually evaluated and the disease itself should be at least 6 months in remission before conception [ 8 ].…”

“…Despite the right timing and deliberate planning, problems can still occur. Evidence from previous studies has shown that pre-eclampsia, small for gestational age and intrauterine growth retardation are more common in SLE pregnancies than in the control population [ 2 , 14 – 16 ]. Additionally, stillbirths occur more often in SLE pregnancies [ 15 , 16 ], and at least one recent study reported increased maternal mortality among SLE mothers [ 17 ].…”