Risk of gestational diabetes mellitus in systemic lupus erythematosus pregnancy: a systematic review and meta-analysis

Dong, Yuanyuan; Dai, Ziwei; Wang, Zhihui; Wang, Hong; Yuan, Feifei; Zhu, Ying; Ye, Dong-Qing; Wang, Bin

doi:10.1186/s12884-019-2329-0

Cited by 19 publications

(17 citation statements)

References 35 publications

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“…Thirteen (27.1%) patients presented with lupus nephritis (LN). This diagnosis of LN was made primarily before pregnancy (10, 76.9%) and confirmed by biopsy in ten (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). This last association was statistically significant (p < 0.0071) (Table 3).…”

Section: Characterization Of Lupus Nephritis Patientsmentioning

confidence: 79%

“…16 Our current results on maternal complications during pregnancy are fully supported by other recently published studies in which common complications, such as premature birth, preeclampsia, thromboembolic disease, fetal death, and gestational diabetes, are significantly higher in patients with SLE. 16,[19][20][21] Preterm labor and birth are of great interest to public health entities because of their significant contribution to perinatal morbidity. Preterm infants are at a greater risk for short and long-term adverse outcomes, higher risk of neonatal death within the first month of life, 22 and neurodevelopmental sequelae.…”

Section: Discussionmentioning

confidence: 99%

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Systemic erythematosus lupus and pregnancy outcomes in a Colombian cohort

Erazo-Martínez

Nieto-Aristizábal

Ojeda

et al. 2021

Lupus

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Objective Pregnant women with SLE have higher probabilities of maternal complications. SLE during pregnancy has alternating patterns of remission and flare-ups; however, most pregnant SLE patients tend to worsen with associated poor obstetric and perinatal outcomes. This study aimed to describe obstetric outcomes in pregnant women with SLE. Methods This retrospective study was performed between 2011 and 2020 at a highly complex referral health center in Cali, Colombia. Pregnant women with a diagnosis of SLE were included. Demographic, clinical, and laboratory features and obstetric and fetal outcomes, including intensive care unit (ICU) characteristics, were evaluated. Results Forty-eight pregnant women with SLE were included. The median age was 29 (25–33.7) years. The SLE diagnosis was made before pregnancy in 38 (79.1%) patients, with a median disease duration of 46 (12–84) months. Thirteen (27.1%) patients had lupus nephritis. Preterm labor (34, 70.8%), preeclampsia (25, 52%), and preterm rupture of membranes (10, 20.8%) were the most common obstetric complications. A relationship between a greater systemic lupus erythematosus pregnancy disease activity index (SLEPDAI) and the development of hypertensive disorders during pregnancy was established (preeclampsia = p < 0.0366; eclampsia = p < 0.0153). A relationship was identified between lupus nephritis (LN) and eclampsia ( p < 0.01), preterm labor ( p < 0.045), and placental abruption ( p < 0.01). Seventeen (35.4%) patients required ICU admission; 52.9% of them were due to AID activity, 17.6% for cardiovascular damage, 11.7% for septic shock, and 5.8% for acute kidney failure. Fetal survival was 89.5% ( N = 43/48). Among the live births, two (4.2%) newborns were diagnosed with neonatal lupus, and two (4.2%) were diagnosed with congenital heart block. One maternal death was registered due to preeclampsia and intraventricular hemorrhage. Conclusions This study is the first to describe SLE during pregnancy in Colombia. SLE was the most prevalent AID in this cohort, and complications included preterm labor, preeclampsia, and postpartum hemorrhage. A higher SLEPDAI and lupus nephritis predicted adverse maternal outcomes.

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Section: Characterization Of Lupus Nephritis Patientsmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Systemic erythematosus lupus and pregnancy outcomes in a Colombian cohort

Erazo-Martínez

Nieto-Aristizábal

Ojeda

et al. 2021

Lupus

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“…The risk of gestational diabetes is also increased in SLE pregnancy [22,36]. It is mainly related to glucocorticoid therapy during pregnancy.…”

Section: Maternal and Fetal Complications During Lupus Pregnancymentioning

confidence: 99%

Systemic Lupus Erythematosus Pregnancy

Fernandes¹,

Bernardino²,

Taulaigo³

et al. 2021

Lupus - Need to Know

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Systemic Lupus Erythematosus (SLE) is an autoimmune disease of unknown etiology that often affects women during childbearing age. Pregnant women with SLE are considered high-risk patients, with pregnancy outcomes being complicated by high maternal and fetal mortality and morbidity. Obstetric morbidity includes preterm birth, fetal growth restriction (FGR), and neonatal lupus syndromes. Active SLE during conception is a strong predictor of adverse pregnancy outcomes and exacerbations of disease can occur more frequently during gestation. Therefore, management of maternal SLE should include preventive strategies to minimize disease activity and to reduce adverse pregnancy outcomes. Patients with active disease at time of conception have increased risk of flares, like lupus nephritis, imposing a careful differential diagnosis of pre-eclampsia, keeping in mind that physiological changes of pregnancy may mimic a lupus flare. Major complications arise when anti-phospholipid antibodies are present, like recurrent pregnancy loss, stillbirth, FGR, and thrombosis in the mother. A multidisciplinary approach is hence crucial and should be initiated to all women with SLE at childbearing age with an adequate preconception counseling with assessment of risk factors for adverse maternal and fetal outcomes with a tight pregnancy monitoring plan. Although treatment choices are limited during pregnancy, prophylactic anti-aggregation and anticoagulation agents have proven beneficial in reducing thrombotic events and pre-eclampsia related morbidity. Pharmacological therapy should be tailored, allowing better outcomes for both the mother and the baby. Immunosuppressive and immunomodulators, must be effective in controlling disease activity and safe during pregnancy. Hydroxychloroquine is the main therapy for SLE due to its anti-inflammatory and immunomodulatory effects recommended before and during pregnancy and other immunosuppressive drugs (e.g. azathioprine and calcineurin inhibitors) are used to control disease activity in order to improve obstetrical outcomes. Managing a maternal SLE is a challenging task, but an early approach with multidisciplinary team with close monitoring is essential and can improve maternal and fetal outcomes.

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“…This may be due to the fact, that lupus develops in a younger age than diabetes mellitus 2 [14]. The relationship between SLE and gestational diabetes has been studied in a meta-analysis [83]. It was found that SLE does not seem to increase the risk of gestational diabetes.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

Endocrine Manifestations of Systemic Lupus Erythematosus

Kostoglou-Athanassiou¹,

Athanassiou²,

Athanassiou³

2021

Lupus - Need to Know

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Systemic lupus erythematosus (SLE) is a systemic autoimmune disease affecting all organ systems. It affects primarily female patients in the reproductive age. The disease has a variable course from very mild to severe and may be fatal. It is characterized by exacerbations of disease activity called flares. Estrogens seem to be involved in SLE pathogenesis as they have multiple immunomodulating properties. In SLE the autoimmune process affects the neuroendocrine axis. Stress modulates disease expression in lupus patients. The disease affects the endocrine system. Hypothyroidism occurs in SLE patients in a higher rate than that of the general population. Hyperthyroidism is also observed in SLE, however, in the rate expected for the general population. Hashimoto’s thyroiditis is observed in SLE in a higher rate than that of the general population. Hyperparathyroidism is also observed in SLE, primary and secondary in the context of renal insufficiency due to lupus nephritis. Addison’s disease is rare in SLE. Cushing’s disease due to an adrenal adenoma has been observed, but it is rare. Ovarian function may be compromised in SLE, due to autoimmune oophoritis or drug toxicity. The recognition of endocrine disease in SLE is important as it may guide proper management and symptom amelioration.

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Risk of gestational diabetes mellitus in systemic lupus erythematosus pregnancy: a systematic review and meta-analysis

Cited by 19 publications

References 35 publications

Systemic erythematosus lupus and pregnancy outcomes in a Colombian cohort

Systemic erythematosus lupus and pregnancy outcomes in a Colombian cohort

Systemic Lupus Erythematosus Pregnancy

Endocrine Manifestations of Systemic Lupus Erythematosus

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