Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE): A Retrospective Study of 109 Pregnancies

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects women during their reproductive years. The interaction between SLE and pregnancy remains debated. The objective of this study was to analyze the fetal and maternal outcomes of Chinese women with SLE. A total of 109 pregnancies in 83 SLE patients from June 2004 to June 2014 at a tertiary university hospital were reviewed retrospectively. Patients’ characteristics, clinical and laboratory data during pregnancy were obtained from electronic medical records. After exclusion of elective abortions, the live birth rate was 61.5%. Significantly, APS (antiphospholipid syndrome), disease activity, hypertension, hypocomplementemia, thrombocytopenia, and anemia during pregnancy were more commonly observed in fetal loss pregnancies than in live birth pregnancies. Compared to the 64 women with a history of SLE, 19 women with new-onset lupus during pregnancy had worse pregnancy outcome. Furthermore, the 64 patients with a history of SLE were divided into lupus nephritis group and SLE group (non-renal involvement). We found that the lupus nephritis group had worse maternal outcome than the SLE group. We conclude that new-onset lupus during pregnancy predicts both adverse maternal and fetal outcomes, while a history of lupus nephritis predicts adverse maternal outcomes. It is essential to provide SLE women with progestational counseling and regular multispecialty care during pregnancy.

Clinical features of new‐onset systemic lupus erythematosus in pregnant patients

“…Previous studies of new-onset SLE patients during pregnancy have reported that such patients are more likely to experience kidney and blood involvement, and adverse maternal and fetal outcomes. 10,11 After comparison of new-onset with pre-existing SLE patients, our results were similar to those of previous studies. Patients with new-onset SLE who flare-up during pregnancy and have disease activity can experience adverse pregnancy outcomes.…”

“…Therefore, we consider that adverse fetal outcomes in new‐onset patients are same as those of active SLE patients. This finding is inconsistent with the results of previous studies . The reason for this difference between studies may relate to our choice of a different control group.…”

“…No difference in kidney involvement was found between new‐onset and active patients. The reason why our results are different to previous studies is that we chose a different control group, which we thought was more appropriate …”

“…12,13 Interestingly, in previous studies, patients with a history of SLE served as a control group and most of these patients were stable with the use of medication. 4,5,10,11 Therefore, we consider that comparing new-onset patients in pregnancy to those with a history of SLE, but who flare-up during pregnancy, is more reasonable. Our study focused on the following factors to assist early Previous studies have reported that flare-ups in patients with SLE occur during the first and second trimesters of pregnancy.…”

Lupus nephritis in pregnancy; a mini-review to current knowledge

“…The goal of lupus treatment is to normalize renal function or at least to prevent progression of renal dysfunction (15). Precise follow up of pregnant women with lupus, treatment of complications and also prevention of teratogenic side effects is important.…”