Outcomes of pregnancy and associated factors in sub-Saharan African women with systemic lupus erythematosus: a scoping review

Abstract

ObjectiveTo scope and summarise available literature on the outcomes of pregnancy and associated factors in sub-Saharan African women with SLE.MethodsElectronic databases and reference lists of retrieved articles were searched to identify relevant studies published from 1 January 2000 to 28 October 2019. Data were combined through narrative synthesis.ResultsWe included four studies retrospectively reporting a total of 137 pregnancies in 102 women over a 26-year period. Mean age at conception ranged from 27.2 to 39.9 years. Kidney damage, the predominant organ manifestation before conception, was reported in 43 (42.2%) patients. Ninety-seven (70.8%) pregnancies resulted in 98 live births. SLE flares occurred in 44 (32.2%) pregnancies, mainly skin (20.4%) and renal (18.2%) flares. Major adverse pregnancy outcomes (APOs) were preterm birth 38.8%, low birth weight 29.8%, pregnancy loss 29.2% and pre-eclampsia 24.8%. The main factors associated with APOs were nephritis and SLE flares.ConclusionOver two-thirds of pregnancies resulted in live birth in this cohort of sub-Saharan African women with SLE. The main APOs and associated factors described in other parts of the world are also seen in this region, but with high rates of APOs. A large prospective multinational study is warranted for more compelling evidence.

Disparities in Lupus and the Role of Social Determinants of Health: Current State of Knowledge and Directions for Future Research

“…Among Medicaid patients with SLE, those who were Black or American Indian/ Alaskan Native patients prescribed hydroxychloroquine were less likely than White patients to receive recommended baseline retinal examinations (86). Although there have been technological advancements and improved maternal-fetal outcomes for women with lupus, pregnancy can complicate active lupus and exacerbate compromised renal function (87). Thus, contraception is important to prevent pregnancy in women with lupus who are at increased risk for health complications or medication teratogenicity with unintended pregnancy.…”

Pregnancy loss in women with systemic lupus erythematosus: Grounded Theory

“…However, with greater diagnostic accuracy and access to health services, pregnancy in women with SLE is possible (10,(23)(24) . Experiencing contraindication, as well as hearing discouraging advice from healthcare professionals, results in emotional turbulence and pessimism, which contribute to psychological illness and favor a complex and negative experience (21,25) .…”

“…In fact, it is important that the disease is in remission for at least six months (3) , because, if conception occurs during the inflammatory activity of the disease, there is a significant increase in "flares" (activation of disease), with inevitable interruption of pregnancy (30) . Reproductive planning is a relevant tool in high-risk pregnancies, especially in autoimmune diseases, favoring the process and positive gestational outcomes (10,(23)(24) . Through this, some women are able to plan and experience a new gestational experience, thus giving new meaning to the "self", although feelings of fear and insecurity are still present.…”

Epidemiology of Sjögren Syndrome in Africa

“…46 The latter can easily be scheduled during SS world day (July 22) and awareness month (April) manifestations. As we have been suggesting for SLE, 46,47 improvement of autoantibody testing and reliable histological analysis of salivary gland biopsies require a strengthening of the local workforce (including rheumatologists and pathologists who are in short supply in many parts of Africa) and capacity building in local laboratories.…”