The association between active proliferative lupus nephritis during pregnancy and small for gestational age newborns

Lacerda, Marcela Ignacchiti; Rodrigues, Bruna Costa; Jesús, Guilherme Ramires de; Santos, Flávia Cunha dos; Jesús, Nilson R. de; Levy, Roger A.; Klumb, Evandro Mendes

doi:10.55563/clinexprheumatol/xspect

Cited by 7 publications

(2 citation statements)

References 27 publications

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“…In many cases, these are attributed to growth problems during pregnancy. The background can be associated with many things, such as maternal smoking (regardless of SLE), high blood pressure, chronic kidney disease, antiphospholipid antibodies, disease-related characteristics and use of drugs [ 4 , 26 , 27 ]. Commonly, all these predisposing things can cause placental dysfunction by several different mechanisms such as inadequate perfusion, thrombosis or uncontrolled activation of complement [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Pregnancies in patients with systemic lupus erythematosus during 2000–2018 in Finland: a case–control study

Elfving,

Kariniemi,

Kautiainen

et al. 2024

Rheumatol Int

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Objectives The aim was to investigate, how pregnancies proceed in patients with systemic lupus erythematosus (SLE) compared to their individually matched population controls. Material and methods Adult incident SLE patients were identified from the register of new special reimbursement decisions for SLE drugs in 2000–2014. For each patient, 1–3 randomly selected controls from the Population Register Centre were matched. Data regarding pregnancies were obtained from the Finnish Medical Birth Register, Care Register and Register of Congenital Malformations until 2018. The study utilized data from the Drug Purchase Register and educational information from Statistic Finland. Results A total of 163 deliveries for 103 mothers with SLE and 580 deliveries for 371 population controls were identified. The duration of pregnancies in SLE women was significantly shorter compared to controls (38.9 versus 39.6 weeks). There were more urgent Caesarean Sections. (15% versus 9%) and need for care at neonatal intensive care unit (NICU) (21% versus 11%) among deliveries in SLE mothers. No statistical difference was observed between SLE and control groups in the occurrence of preeclampsia or major congenital malformations. Gestational age was 2.5 weeks shorter when the mother experienced pre-eclampsia. Hydroxychloroquine was purchased by 30% of SLE mothers during pregnancy. Conclusion The course of pregnancies in Finnish SLE patients seems to be quite moderate compared to controls, and no new safety issues were detected. The low utilization of hydroxychloroquine indicates that the benefits of the drug to pregnancy and disease course are not optimally recognized by specialists treating SLE mothers.

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Section: Discussionmentioning

confidence: 99%

Pregnancies in patients with systemic lupus erythematosus during 2000–2018 in Finland: a case–control study

Elfving,

Kariniemi,

Kautiainen

et al. 2024

Rheumatol Int

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“…Studies have consistently shown that SLE patients with active LN during pregnancy experience significantly higher incidences of lupus flares, fetal loss, PE or eclampsia, preterm birth, and FGR. [ 24 , 25 ] While pulmonary arterial hypertension (PAH) is relatively rare in SLE patients, it is associated with a poor prognosis and high mortality rate during pregnancy. [ 26 ] A systematic review analyzed 13 studies including 272 pregnant women with PAH.…”

Section: Determination Of Pregnancy Timing In Sle Patientsmentioning

confidence: 99%

2022 Chinese guideline for the management of pregnancy and reproduction in systemic lupus erythematosus

Tian,

Zhao,

Song

et al. 2023

Rheumatology and Immunology Research

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Systemic lupus erythematosus (SLE), a prevalent autoimmune disease predominantly affecting women of childbearing age, presents ongoing challenges despite notable advances in diagnosis and treatment. Although survival rates for SLE patients have significantly improved, pregnancy continues to pose a considerable obstacle. Addressing this critical need for enhanced reproductive and prenatal care, there is a pressing imperative to establish standardized protocols for peri-gestational monitoring and treatment in SLE patients. This guideline is jointly sponsored by the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), the Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR), and the Chinese Research Committee of Pregnancy and Reproduction in Autoimmune Rheumatic Diseases (CHOPARD). Thirteen pertinent clinical questions have been generated through several rounds of rigorous clinical and methodological expert discussions and selections for a comprehensive understanding of key aspects in this domain. Guided by thorough examination of research evidence and expert perspectives, the formulated recommendations aim to optimize pregnancy success rates, reduce maternal and infant mortality rates, and ultimately enhance the overall well-being of SLE patients.

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Active but not quiescent lupus nephritis during pregnancy is associated with a higher rate of adverse obstetric outcomes: Analysis of a prospective cohort

Saavedra,

Gracia‐Aréchiga,

Miranda‐Hernández

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo compare the maternal‐fetal/neonatal outcome in patients with systemic lupus erythematosus (SLE) with and without lupus nephritis (LN) in remission or with active disease.MethodsA prospective cohort of pregnant patients with SLE (ACR 1997 criteria) was studied from January 2009 to December 2021. Demographic, clinical, biochemical, and immunological variables as well as the usual maternal‐fetal/neonatal complications were recorded. We compared four groups according to the status of SLE during pregnancy: patients with quiescent SLE without lupus nephritis, patients with active SLE without lupus nephritis, patients with quiescent lupus nephritis, and patients with active lupus nephritis. Statistical analysis included descriptive statistics, bivariate analysis, and Cox regression analysis.ResultsA total of 439 pregnancies were studied, with a median age of 28 ± 6, SLE duration of 60 months (interquartile range 36–120). A higher frequency of maternal and fetal/neonatal complications was observed in patients with active SLE with or without lupus nephritis. Multivariate analysis showed that active LN was a risk factor for gestational hypertension (hazard ratios [HR] 1.95; 95% confidence intervals [CI]: 1.01–6.39), premature rupture of membranes (HR 3.56; 95% CI: 1.79–16.05) and more frequent cesarean section (HR 1.82; 95% CI: 1.13–2.94).ConclusionLN is associated with a higher frequency of maternal complications, especially in those patients with active disease during pregnancy, and those maternal complications had an impact on poor fetal/neonatal outcomes. Strict control and timely care of LN could improve the obstetric prognosis.

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The association between active proliferative lupus nephritis during pregnancy and small for gestational age newborns

Cited by 7 publications

References 27 publications

Pregnancies in patients with systemic lupus erythematosus during 2000–2018 in Finland: a case–control study

Pregnancies in patients with systemic lupus erythematosus during 2000–2018 in Finland: a case–control study

2022 Chinese guideline for the management of pregnancy and reproduction in systemic lupus erythematosus

Active but not quiescent lupus nephritis during pregnancy is associated with a higher rate of adverse obstetric outcomes: Analysis of a prospective cohort

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