The presence of lupus nephritis additionally increases the risk of preeclampsia among pregnant women with systemic lupus erythematosus

Abstract

Introduction Pregnant women with systematic lupus erythematosus (SLE) have an increased risk of obstetric complications, such as preeclampsia and premature births. Previous studies have suggested that renal involvement could further increase the risk for adverse obstetric outcomes. Aims: The aim of this study was to compare the obstetric outcomes in a Swedish cohort of patients with SLE with and without lupus nephritis (LN). Patients and methods The study was conducted as a retrospective observational study on 103 women with SLE, who gave birth at the Karolinska University Hospital between the years 2000-2017. Thirty-five women had previous or active LN and 68 women had non-renal lupus. Data was collected from digital medical records. The outcomes that were analysed included infants born small for gestational age (SGA), premature birth, preeclampsia, SLE- or nephritis flare and caesarean section. Results Women with LN, both with previous and with renal flare during pregnancy suffered from pre-eclampsia more often compared to women with non-renal lupus (25.7% vs 2.9%, p = 0.001) and this complication was associated with premature birth (p = 0.021) and caesarean section (p = 0.035). Conclusions Lupus nephritis is a significant risk factor for adverse obstetric outcomes in women with SLE, including preeclampsia. Those patients could benefit from more frequent antenatal controls and more vigorous follow-up.

Maternal and fetal outcomes in pregnancy complicated by pre-existing lupus nephritis: Insights from a developing country Pakistan

“…The latter may be because 17% were not taking any immunosuppressants or low-dose steroids, while 19% were taking MMF which was replaced with AZA once pregnancy was confirmed. Furthermore, we found no statistically significant difference in maternal and fetal outcomes between proliferative and nonproliferative LN that is contrary to the findings by Rodrigues et al 27 There is an increased risk of PE in lupus pregnancies as compared to the general population, 19,[28][29][30][31][32] and this risk increased further in those who have prior renal involvement because of multiple factors. Among these, arterial hypertension 1,25 and renal flare are most important.…”

Pregnancy in Glomerular Disease: From Risk Identification to Counseling and Management

“…The changes in the immune system during pregnancy have the potential to trigger flares of systemic lupus erythematosus (SLE), particularly in cases in which there is kidney involvement [ 82 , 83 , 84 , 85 , 86 ].…”

“…Studies highlight that pregnant women with lupus nephritis (LN) have an increased risk of complications, including gestational hypertension, flares, irreversible kidney damage, and PE [ 84 , 85 , 86 , 87 , 88 ]. The risk of maternal mortality (20-fold increased) and various complications, such as thrombosis, thrombocytopenia, infection, and the need for transfusion (three- to sevenfold increased), is significantly elevated in women with SLE during pregnancy in a study published in 2008 [ 89 ].…”

“…Additionally, pregnant women with SLE and renal involvement have a higher risk of spontaneous miscarriage, preterm delivery, neonatal death, intrauterine growth restriction (IUGR), and SGA compared to the general population [ 84 , 85 , 91 ].…”

Dilemma of belimumab therapy (dis)continuation during pregnancy: Results of a retrospective study in eudravigilance

“… 2 Active SLE and nephritis due to SLE contribute to poor pregnancy outcomes and higher morbidities and mortalities in the mothers and their foetuses. 3 Limited treatment options are available for the management of SLE during pregnancy, especially for the treatment of SLE nephritis. Corticosteroids, azathioprine, hydroxychloroquine, ciclosporin and tacrolimus are considered safe treatments.…”