Fetal Outcome in Lupus Pregnancy: A Retrospective Case-Control Study of 242 Pregnancies in 112 Patients

Abstract

Fetal outcome in systemic lupus erythematosus (SLE) was retrospectively analysed in 242 pregnancies in 112 unselected patients, and the outcome was compared with that of 417 pregnancies in 192 control women matched for age, parity and socio-economic status. Relative risk for fetal loss after the diagnosis of SLE was 2.5 (95% confidence interval (CI), 1.4-4.5), for prematurity 5.8 (3.2-10.5) and for intra-uterine growth retardation (IUGR) 8.6 (3.0-24.3). Fetal outcome of pregnancy in patients with pre-existing stable lupus nephritis was no worse than in other SLE pregnancies. Relations of three lupus anticoagulant (LA) assays and tree anticardiolipin (aCL) enzyme-linked immunosorbent assays to fetal outcome were studied. Patients positive by any LA assay had a previous fetal loss more often than patients negative by all LA assays (odds ratio 3.4; 95% CI, 1.3-9.0; P = 0.01). Of the 41 patients whose antiphospholipid antibody (aPL) tests were all negative, five (12%) had a history of fetal loss (16% in controls). As a group, aCL was more sensitive for fetal loss than LA (64% vs 50%), but LA was more specific (77% vs 52%). Combinations of one aCL assay with one LA assay had a 41-73% sensitivity and a 64-73% specificity for a history of fetal loss. aPL did not correlate to prematurity or fetal growth retardation. In conclusion, fetal loss in SLE is 2.5 times more prevalent than in the normal population. The presence of LA indicates a high risk for fetal loss, and the absence of aPL is an indication of a favorable pregnancy outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Pregnancy Outcomes in Female Renal Recipients: A Comparison of Systemic Lupus Erythematosus With Other Diagnoses

“…There were 10 (2.6%) stillbirths in the non-SLE group, similar to 3% reported in the renal transplant literature (53). There were no stillbirths in the SLE group, although published reports cite an expected two-fold increase in stillbirths among nontransplant SLE pregnancies (54,55).…”

“…Prematurity is reported to occur in 24-59% of non-transplant SLE pregnancies (36,46,50,55) compared with 45-60% of renal transplant recipient pregnancies (35,38,53). Preterm birth was common in both groups (SLE 42%, non-SLE 55%).…”

Lupus and Pregnancy: Complex Yet Manageable

“…As mentioned previously, fetal growth restriction is a serious concern in pregnancies complicated by lupus 44,61 and occurs more frequently in such pregnancies. Fetal growth restriction can occur even before the lupus is apparent in the mother which suggests a pre-disease state.…”

“…18,35,[38][39][40][41][42][43][44] The frequencies of spontaneous abortions and stillbirths are increased in women with lupus, with the stillbirth rate nearly 5 times greater than for non-lupus pregnancies. 20 45 Adverse live birth outcomes correlate with lower pregestational serum albumin levels, elevated gestational anti-double-stranded DNA antibody titers and diabetes.…”

“…17 If pregnancies occur when the lupus disease is active, if there is a history of major organ involvement (e.g., renal or central nervous system), or if there is renal impairment, they are more likely to result in poor fetal and maternal outcomes. 18,[38][39][40][41][42][43][44][48][49][50][51][52][53] Immunosuppressive medications should be minimized or discontinued, provided lupus disease activity is quiescent, to reduce exposure risk to the developing fetus particularly in the first trimester. However, if the patient requires immunosuppressive therapy for maintaining disease control, the woman should be kept on a regimen with the lowest risk to the fetus.…”