The impact of increased lupus activity on obstetric outcomes

Abstract

Objective. Systemic lupus erythematosus is associated with multiple adverse pregnancy outcomes. We examined the impact of disease activity on spontaneous abortions, perinatal mortality, preterm delivery, and birth weight.Methods. The study was designed to assess all pregnancies in a cohort of lupus patients who were observed prospectively from 1987 to 2002. At each visit, the physician's estimate of lupus activity was determined on a visual analog scale (high-activity lupus defined as a score of >2). Disease activity in each trimester was compared. We assessed the impact of high-activity lupus during pregnancy on gestational age, live birth rate, and small for gestational age babies. Potential confounders, including demographics of the women as well as maternal history of lupus, renal lupus, and antiphosphoplipid antibody syndrome, were analyzed through multivariate analysis.Results. Two hundred sixty-seven pregnancies were observed. Of these, 229 (85.8%) resulted in a live birth. High-activity lupus occurred in 57 pregnancies (21%). Fewer pregnancies among women with highactivity lupus ended with live births (77% versus 88% of those with low-activity lupus; P ‫؍‬ 0.063). Full-term delivery was achieved in 15 pregnancies (26%) among women with high-activity lupus, compared with 127 pregnancies (61%) achieving full-term in those with no or mild lupus activity (P < 0.001). High-activity lupus in the first and second trimesters led to a 3-fold increase in pregnancy loss (miscarriages and perinatal mortality).Conclusion. High-activity lupus during pregnancy leads to increased premature birth and a decrease in live births, with almost one-quarter of these pregnancies resulting in fetal loss. Pregnancies in lupus patients must be closely watched and treated during all trimesters to improve pregnancy outcomes.Systemic lupus erythematosus (SLE) is a disease that affects primarily women of reproductive age. The peak incidence of SLE occurs between the ages of 15 and 40 years, with an estimated female-to-male SLE incidence of 9:1. Previous studies have demonstrated that women with SLE maintain fertility, leading to the potential for a large number of pregnancies in this population (1). Pregnancies in women with lupus, however, have poorer obstetric outcomes than pregnancies in healthy women. These pregnancies have higher rates of preterm delivery and fetal loss, and the mothers and newborns have longer hospital stays than that experienced by women without lupus (2-4).The impact of increased lupus activity on pregnancy outcomes is a subject of debate in the literature. Some reports indicate that lupus activity, particularly lupus nephritis, increases the risk of fetal loss (3,(5)(6)(7). Other studies show no statistically significant difference between pregnancies in women with active lupus and those in women with inactive lupus (8-10). The first 74 pregnancies in the Hopkins Lupus Cohort were previously analyzed in a report published in 1992 (11). This analysis found that the occurrence of a lupus flare during pregnancy d...

A national study of the complications of lupus in pregnancy

“…(11,24) This study confirms that preeclampsia is a significant problem in SLE pregnancies. We included ICD-9 codes for hypertension in pregnancy, mild and severe preeclampsia in this category.…”

A Systematic Review and Meta-Analysis of Pregnancy Outcomes in Patients with Systemic Lupus Erythematosus and Lupus Nephritis

“…Severe complications, including eclampsia, stroke, and maternal death, were observed in ϳ1% of subjects. Maternal deaths occurred because of opportunistic infections, sepsis, flares of lupus nephritis, and renal impairment (3,7,11,17,22,30,33,35). Of these deaths, three of the reported cases described the renal histologic subclass, and all had proliferative disease (7,17,22).…”

Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus

“…In prospective cohorts, the rate of miscarriage is similar between women with SLE and healthy women, but the rate of stillbirth is 5-to 10-fold higher in patients with SLE than in the general population (24 -26). Pregnancy loss in SLE is most strongly associated with increased SLE activity prior to and during pregnancy (25). It may be hypothesized that systemic inflammation from SLE activity impairs placentation and promotes cervical ripening or preterm labor, all of which increase the risk for pregnancy loss.…”