High-risk factors for adverse pregnancy outcomes in systemic lupus erythaematosus: a retrospective study of a Chinese population

Abstract

ObjectiveTo clarify high-risk factors for adverse pregnancy outcomes (APOs) in systemic lupus erythaematosus (SLE).DesignA retrospective chart review study.SettingData were collected in a tertiary medical centre, Shanghai, China, from November 2010 to December 2018.ParticipantsA total of 513 pregnancies with SLE were retrospectively analysed. Twenty-seven patients who underwent artificial abortions due to personal reasons were excluded.Primary outcome measuresAPOs were primary outcomes, including foetal loss, premature birth, small for gestational age (SGA), asphyxia neonatorum, composite foetal APOs and hypertensive disorders of pregnancy (HDP). Multivariable logistic regression and Spearman correlation analysis were performed to determine the risk factors for APOs in SLE.ResultsRisk factors for foetal loss included prepregnancy hypertension, hypocomplementaemia-C3, anticardiolipin antibodies-IgM positivity and disease flares during pregnancy. Risk factors for premature birth included disease flares, use of immunosuppressive agents and HDP. Moreover, twin pregnancy, disease flares and HDP were risk factors for SGA, and prepregnancy hypertension was an independent risk factor for asphyxia neonatorum. Independent risk factors for composite foetal APOs included twin pregnancy, prepregnancy hypertension, disease flares during pregnancy, HDP, hypocomplementaemia-C3 and the use of immunosuppressive agents. Risk factors for SLE complicated with HDP included prepregnancy hypertension, renal disorders and thrombocytopaenia. Conversely, the use of aspirin was a protective factor against foetal loss and premature birth. The ds-DNA value had a low diagnostic value for APOs, whereas the extent of complement reduction may predict the incidence of composite foetal APOs and foetal loss. Proteinuria occurring in the first 20 gestational weeks may lead to APOs.ConclusionEstablished risk factors for each APO were identified in this study. Indicators with more predictive significance have been screened out from conventional indicators, which may help clinicians predict the pregnancy outcome of patients with SLE more accurately and minimise the incidence of APOs.

Adverse Impact of Systemic Lupus Erythematosus on Pregnancy Outcomes: A Saudi Arabia Retrospective Multi-Center Study

“…It has been proposed that adverse pregnancy outcomes in SLE patients especially fetal losses were related to hypocomplementemia particularly C3, antiphospholipid antibodies, and pre-pregnancy hypertension. 26,29 Similar findings were reported in a meta-analysis conducted by Smyth et al that patients with antiphospholipid antibodies/antiphospholipid syndrome are at higher risk for maternal hypertension and premature birth. 8 A previous study showed that the presence of aPL antibodies in patients with SLE significantly affected the rate of pregnancy loss compared to patients without aPL with no effect of hypocomplementemia on pregnancy outcome.…”

Reconciling Between Medication Orders and Medication Fills for Lupus in Pregnancy

“…In a retrospective cohort using Truven Health Marketscan data from 2006 to 2012, 42.8% of 1634 pregnant women with lupus used HCQ ( 11 ). In two clinical settings, 63.7% of 215 lupus pregnancies from 1993 to 2019 in a tertiary hospital in Portugal used HCQ ( 12 ), and 78.9% of 513 pregnancies from 2010 to 2018 from a single center in Shanghai, China, took HCQ ( 13 ). Using Swedish Registers (2006–2012), we showed that during lupus pregnancy, 36.4% filled HCQ, 20.7% filled azathioprine, and 48.0% filled a corticosteroid prescription.…”

Metabolomics profiling reveals low blood tyrosine levels as a metabolic feature of newborns from systemic lupus erythematosus pregnancies

“…The offspring of mothers with SLE are confronted with adverse outcomes, such as preterm birth, low birth weight, neonatal lupus syndrome, and long-term neurological complications whose precise etiology remains elusive ( 1 , 14 , 15 ). Metabolomics investigations have revealed distinct metabolic profiles in both patients and pregnant women with SLE ( 11 , 13 ).…”