Pregnancy in Women with Systemic Lupus Erythematosus: A Retrospective Study of 83 Pregnancies at a Single Centre
Abstract
:1. Introduction
2. Patients and Methods
2.1. Patients
2.2. Assessment of SLE
2.3. Maternal and Fetal Outcome
2.4. Follow-Up
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
Group A | Group B | Group C | |
---|---|---|---|
Patients (Pregnancies) | N = 49 (51) | N = 13 (13) | N = 19 (19) |
Age (years) * | 28.31 ± 3.61 | 25.85 ± 5.11 | 26.90 ± 3.00 |
SLE duration (years) | 5 (4–9) | 2 (2–7) | 0 |
Smoker | 0 | 0 | 0 |
Hypertension ( before pregnancy) | 0 | 2 | 0 |
Proteinuria | 0 | 2 | 0 |
Renal failure | 0 | 0 | 0 |
Drugs taken from 6 months before pregnancy to onset of pregnancy | |||
Prednisone/methylprednisolone | 30 | 11 | 0 |
Hydroxychloroquine | 7 | 0 | 0 |
Methotrexate | 0 | 3 | 0 |
Mycophenolate mofetil | 0 | 1 | 0 |
Leflunomide | 0 | 1 | 0 |
3.2. The Impact of SLE on Pregnancy
3.2.1. Fetal Outcome (Table 2)
Group A | Group B | Group C | p Value | |
---|---|---|---|---|
Pregnancies/Fetus | N = 51/52 | N = 13/13 | N = 19/19 | |
Full-term deliveries (vaginal delivery/caesarean) | 39 (21/18) | 3 (1/2) | 6 (3/3) | <0.001 |
Small-to-date infant | 5 | 1 | 1 | |
Prematurity | 4 (5 neonates) | 2 | 5 | 0.10 |
Live born infants | 42 | 4 | 9 | 0.17 |
Still birth | 2 | 1 | 2 | 0.43 |
Therapeutic abortion | 4 | 5 | 6 | 0.005 |
Elective abortion | 2 | 0 | 0 | 1.00 |
Spontaneous abortion | 1 | 2 | 0 | 0.17 |
Loss-to-follow up | 1 | 1 | 2 | 0.23 |
3.2.2. Maternal Outcome and Obstetric Complications (Table 3)
Group 1 | Group 2 | Group 3 | p Value | |
---|---|---|---|---|
Patients (Pregnancies) | N = 49 (51) | N = 13 (13) | N = 19 (19) | |
Obstetric complicates | ||||
New onset hypertension | 9 | 3 | 12 | 0.001 |
Pre-eclampsia | 4 | 2 | 5 | 0.18 |
Eclampsia | 1 | 0 | 1 | 0.63 |
HELLP syndrome | 0 | 0 | 1 | |
Lupus manifestation | ||||
Leukocytopenia | 1 | 1 | 6 | 0.006 |
Thrombocytopenia | 6 | 3 | 7 | 0.18 |
Hematuria | 13 | 8 | 17 | 0.01 |
Proteinuria | 18 | 11 | 18 | 0.04 |
Nephrotic syndrome | 10 | 7 | 14 | 0.02 |
Renal failure | 3 | 1 | 1 | 0.96 |
Heart failure | 2 | 0 | 4 | 0.054 |
Polyserositis | 3 | 2 | 6 | 0.06 |
New onset skin lesions | 3 | 4 | 9 | 0.004 |
Arthralgia | 0 | 2 | 4 | 0.005 |
Dental ulcer | 0 | 1 | 1 | 0.20 |
Hepatitis | 0 | 0 | 1 | 0.20 |
Laboratory | ||||
Anti-dsDNA | 9 | 6 | 11 | 0.052 |
Anti-Smith | 5 | 5 | 8 | 0.03 |
Anti-SSA | - | - | 12 | |
Anti-SSB | - | - | 3 | |
Anti-phospholipid antibody | - | - | 2 | |
Hypocomplementamia | ||||
C 3 | 16 | |||
C4 | 15 |
3.3. The Impact of Pregnancy on SLE (Lupus Flare)
3.4. Therapy Protocol (Table 4)
Group 1 | Group 2 | Group 3 | |
---|---|---|---|
Patients (Pregnancies) | N = 49 (51) | N = 13 (13) | N = 19 (19) |
During pregnancy | |||
Prednisone (<0.5 mg/kg) | 21 | 4 | 0 |
Prednisone (1 mg/kg) | 8 | 7 | 16 |
High-dose intravenous methylprednisolone | 2 | 2 | 1 |
Anti-hypertensive agents | 3 | 3 | 11 |
Low molecular weight heparin | 0 | 2 | 1 |
Hydroxychloroquine | 2 | 2 | 7 |
Hemodialysis | 0 | 0 | 1 |
Plasmapheresis | 0 | 1 | 0 |
Postpartum | |||
Prednisone/prednisone | 32 | 13 | 17 |
Cyclophosphamide | 1 | 2 | 0 |
Methotrexate | 1 | 1 | 0 |
Azathioprine | 0 | 0 | 1 |
3.5. New Onset SLE during Pregnancy (Table 5)
First | Second | Third | p Value | |
---|---|---|---|---|
Pregnancies/Fetus | N = 3/3 | N = 8/8 | N = 8/8 | |
Full-term deliveries | 0 | 1 | 5 | 0.04 |
Small-to-date infant | 0 | 0 | 1 | 1.00 |
Prematurity | 1 | 1 | 3 | 0.50 |
Live born infants | 1 | 1 | 7 | 0.006 |
Still birth | 0 | 1 | 1 | 1.00 |
Therapeutic abortion | 2 | 4 | 0 | 0.04 |
Loss-to-follow up | 0 | 2 | 0 | - |
3.6. Follow-Up Post Delivery
3.7. Risk Factors for Lupus Flare, Obstetric Complications and Fetal Loss in Pregnant Women with SLE (Table 6)
Unadjusted Model | Adjusted Model | |||
---|---|---|---|---|
OR (95% CI) | p Value | OR (95% CI) | p Value | |
Lupus flare | ||||
Age | 0.88 (0.78–0.99) | 0.04 | 0.92 (0.80–1.06) | 0.26 |
Lupus nephritis | 2.44 (1.02–5.84) | 0.05 | 1.92 (0.61–6.02) | 0.26 |
New onset SLE during pregnancy | - | - | - | - |
SLE disease activity in the six months before pregnancy | 3.15 (0.80–12.42) | 0.10 | 5.00 (1.14–21.87) | 0.03 |
Obstetric complications | ||||
Age | 0.95 (0.83–1.07) | 0.38 | 0.99 (0.86–1.15) | 0.94 |
Lupus nephritis | 2.61 (1.00–6.84) | 0.05 | 2.31 (0.76–7.01) | 0.14 |
New onset SLE during pregnancy | 6.73 (2.21–20.48) | 0.001 | 7.22 (2.14–24.38) | 0.001 |
SLE disease activity in the six months before pregnancy | 1.04 (0.29–3.74) | 0.96 | 1.65 (0.39–7.09) | 0.50 |
Fetal loss | ||||
Age | 0.86 (0.75–0.99) | 0.03 | 0.91 (0.78–1.05) | 0.18 |
Lupus nephritis | 2.08 (0.83–5.17) | 0.12 | 1.39 (0.53–3.66) | 0.51 |
New onset SLE duringpregnancy | 2.01 (0.69–5.84) | 0.20 | 2.82 (0.85–9.38) | 0.09 |
SLE disease activity in the six months before pregnancy | 4.99 (1.44–17.30) | 0.01 | 5.73 (1.42–23.05) | 0.02 |
Fetal loss (without therapeutic/elective abortion) | ||||
Age | 0.93 (0.75–1.16) | 0.53 | 0.94 (0.74–1.20) | 0.63 |
Lupus nephritis | 1.12 (0.32–3.94) | 0.86 | 0.78 (0.18–3.34) | 0.73 |
New onset SLE during pregnancy | 1.42 (0.25–8.03) | 0.69 | 2.49 (0.35–17.54) | 0.36 |
SLE disease activity in the six months before pregnancy | 6.36 (1.16–34.81) | 0.03 | 8.70 (1.30–58.28) | 0.03 |
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Chen, S.; Sun, X.; Wu, B.; Lian, X. Pregnancy in Women with Systemic Lupus Erythematosus: A Retrospective Study of 83 Pregnancies at a Single Centre. Int. J. Environ. Res. Public Health 2015, 12, 9876-9888. https://doi.org/10.3390/ijerph120809876
Chen S, Sun X, Wu B, Lian X. Pregnancy in Women with Systemic Lupus Erythematosus: A Retrospective Study of 83 Pregnancies at a Single Centre. International Journal of Environmental Research and Public Health. 2015; 12(8):9876-9888. https://doi.org/10.3390/ijerph120809876
Chicago/Turabian StyleChen, Shanying, Xuejuan Sun, Bide Wu, and Xuejian Lian. 2015. "Pregnancy in Women with Systemic Lupus Erythematosus: A Retrospective Study of 83 Pregnancies at a Single Centre" International Journal of Environmental Research and Public Health 12, no. 8: 9876-9888. https://doi.org/10.3390/ijerph120809876
APA StyleChen, S., Sun, X., Wu, B., & Lian, X. (2015). Pregnancy in Women with Systemic Lupus Erythematosus: A Retrospective Study of 83 Pregnancies at a Single Centre. International Journal of Environmental Research and Public Health, 12(8), 9876-9888. https://doi.org/10.3390/ijerph120809876