Pregnancy outcomes among women with systemic lupus erythematosus: a retrospective cohort study from Thailand

Abstract

Objective The objective of this paper is to compare adverse pregnancy outcomes between normal pregnancies and pregnancies with systemic lupus erythematosus (SLE), particularly focusing on uncomplicated SLE with remission. Methods A retrospective cohort study was conducted by accessing the Maternal-Fetal Medicine (MFM) Unit database and the full medical records of the women. The records of singleton pregnancies with SLE and no underlying disease were assigned as the study group and their medical records were reviewed. The low-risk pregnancies were randomly selected as the controls. The adverse pregnancy outcomes were compared between the control group vs women with SLE, control group vs uncomplicated SLE, and between the subgroups within the study group. Results Of 28,003 births during the study period, 1400 controls and 140 pregnancies with SLE were compared. The rates of fetal loss, preterm birth, small-for-date, low birth weight and preeclampsia were significantly higher in the study groups with a relative risk of 5.6 (95% CI: 2.9-10.9), 3.2 (95% CI: 2.5-4.1), 3.5 (95% CI: 2.4-4.9), 4.2 (95% CI: 3.4-5.3) and 2.9 (95% CI: 1.9-4.4), respectively. The increased rates of most adverse outcomes were still noted even in the cases of uncomplicated SLE. Among women with SLE, lupus nephritis, chronic hypertension, antiphospholipid syndrome, active disease at the onset of pregnancies, and proteinuria were significantly associated with such outcomes. Conclusions Pregnancies with SLE, even in uncomplicated cases with remission, increase the risk of poor pregnancy outcomes. The presence of lupus nephritis, chronic hypertension, antiphospholipid syndrome, active disease at the onset of pregnancies, and proteinuria were significantly associated with such outcomes.

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

“…The previous studies have been reported the relapse rates ranged from 13 to 68%. Generally, the frequency of outcomes evaluated in this study is within the reported range from other studies [15][16][17].…”

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

“…As standard good practice, we strongly suggest counseling women with RMD who are considering pregnancy regarding the improved maternal and fetal outcomes (based on many studies) associated with entering pregnancy with quiescent/low activity disease ( ). As additional good practice, we suggest maintaining concurrent care with specialists in obstetrics‐gynecology, maternal‐fetal medicine, neonatology, and other specialists as appropriate.…”

Pregnancy Loss and Carotid Intima–Media Thickness in Mexican Women

“…First, we excluded women who self‐reported a diagnosis of lupus or rheumatoid arthritis. These autoimmune conditions are strong predictors of pregnancy loss and are associated with increased cardiovascular risk 23. Second, we repeated analyses comparing women with a history of stillbirth only and women with no history of pregnancy loss.…”

“…These autoimmune conditions are strong predictors of pregnancy loss and are associated with increased cardiovascular risk. 23 Second, we repeated analyses comparing women with a history of stillbirth only and women with no history of pregnancy loss. Third, we evaluated 2 alternative definitions of SCA: (1) IMT ≥1.0 mm or plaque and (2) only plaque.…”