Systemic lupus erythematosus pregnancies: the Sarawak experience and review of lupus pregnancies in Asia

Abstract

We performed a cross-sessional study of all systemic lupus erythematosus (SLE) pregnancies during a 4-year period (2006-2009) to describe the clinical features, maternal and foetal outcomes in our centre. There were 48 pregnancies in 44 women with SLE. Our patients have a mean age of 30.0 years (SD 6.36) and a mean disease duration of 40.67 months (SD 48.23). Our patients have complicated pregnancies: 32.7% have SLE flares, 17.3% have preeclampsia and 48.9% needed caesarean sections. There were 20.0% foetal losses and 17.8% preterm deliveries in our patients. SLE flares contributed to 60.0% of foetal losses in our patients. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable to developed countries in Asia. The low incidence of APS, the high usage of hydroxychloroquine and the high SLE remission rate in our patients prior to conceptions contributed to the good outcome.

Pregnancy outcomes and contraceptive use in patients with systemic lupus Erythematosus, rheumatoid arthritis and women without a chronic illness: a comparative study

“…Exacerbations of SLE during pregnancy occurred in 30.8% of patients in our study. This is higher than the values of 13‐33% reported from most previous studies on exacerbations during pregnancy . This is most likely to be due to higher numbers of unplanned pregnancies recorded in our study, as all of the pregnancies which had exacerbations were unplanned.…”

“…Similar percentage of live births (85.6%) was found in a prospective study on pregnancy outcomes in a Johns Hopkins Lupus cohort in a 16‐year period . The live birth percentage was 66% in a prospective study in a lupus cohort in Spain over a 15‐year period while the fetal loss reported was 20% in Sarawak, Malaysia . An Indian study of 71 pregnancies in 35 women with SLE, reported the incidence of abortion and perinatal loss of 33.8% and 12.67%, respectively .…”

“…Although early studies indicated poor pregnancy prognosis more recent data have shown improved outcomes, with live birth percentages reaching 96% in SLE patients with planned pregnancies, close to general population figures . However in developing countries and in unplanned pregnancies, the pregnancy outcome is still lower than these figures …”

Related factors of fetal loss in Chinese women with systemic lupus erythematosus: data from Chinese SLE Treatment and Research Group registry IV

“…A national study in the United States had shown that the chance of pregnancy complications occurrence was 2‐ to 4.8‐fold higher in SLE patients than the general population . SLE flares contributed to 60.0% of fetal loss in a report from Sarawak . In our study, we could not find a difference in SLEDAI between patients with fetal loss and normal pregnancies.…”

“…15,16 SLE flares contributed to 60.0% of fetal loss in a report from Sarawak. 17 In our study, we could not find a difference in SLEDAI between patients with fetal loss and normal pregnancies. The similarity in clinical presentations of the two groups, except arthritis and serositis which contribute less to the total score of SLEDAI, might be the explanation.…”