Abstract
Systemic lupus erythematosus (SLE) is mainly a disease of fertile women and the coexistence of pregnancy is by no means a rare event. How SLE and its treatment affects pregnancy outcome is still a matter of debate. Assessment of the reciprocal clinical impact of SLE and pregnancy was investigated in a cohort study. We reviewed the clinical features, treatment, and outcomes of 43 pregnant SLE patients with 51 pregnancies followed from 1993 to 2007 at a tertiary university hospital. The age of patients was 28.7 ± 5.4 years and SLE was diagnosed at age of 23.0 ± 6.1 years. Previous manifestations of SLE included lupus nephritis (14 patients) and secondary antiphospholipid syndrome (11 patients). Thirty-five pregnant patients (69%) were in remission for more than 6 months at the onset of pregnancy. Patients were being treated with low doses of prednisone (29), hydroxychloroquine (20), azathioprine (five), acetylsalicylic acid (51), and low molecular weight heparin (13). Sixteen pregnancy-associated flares were documented, mainly during the second trimester (42%) and also in the following year after delivery (25%). Renal involvement was found in 11 cases (68%). Spontaneous abortion occurred in 6%, 16% had premature deliveries, and 74% were delivered at term. No cases of maternal mortality occurred. No cases of fetal malformation were recorded. There was one intrauterine fetal death and one neonatal death at 24 gestational weeks. Pregnant women with SLE are high risk patients, but we had a 90% success rate in our cohort. A control disease activity strategy to target clinical remission is essential.
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Mecacci F, Pieralli A, Bianchi B, Paidas MJ (2007) The impact of autoimmune disorders and adverse pregnancy outcome. Semin Perinatol 31:223–226
Chakravarty EF, Colón I, Langen ES, Nix DA et al (1982) Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. Am J Obstet Gynecol 142:159–164
Khamashta MA (2006) Systemic lupus erythematosus and pregnancy. Best Pract Res Clin Rheumatol 20(4):685–694
Clowse MEB (2007) Lupus activity in pregnancy. Rheum Dis Clin N Am 33:237–252
Gordon C (2004) Pregnancy and autoimmune diseases. Best Pract Res Clin Rheumatol 18(3):359–379
D’Cruz DP, Khamashta MA, Hughes GRV (2007) Systemic lupus erythematosus. Lancet 369:587–596
Ruiz-Irastorza G, Khamashta MA (2004) Evalution of systemic lupus erythematosus activity during pregnancy. Lupus 13:679–682
Tincani A, Faden D, Tarantini M et al (1992) Systemic lupus erythematosus and pregnancy: a prospective study. Clin Exp Rheumatol 10:439–446
Lima F, Buchanam NM, Khamashta MA, Kerslake S, Hughes GRV (1995) Obstetric outcome in systemic lupus erythematosus. Semin Arthritis Rheum 25:184–192
Laskin CA, Clark C, Sptitzer KA. Decrease in pregnancy loss rates in systemic lupus erythematosus over a 40-year period. Fertil Steril—Abstracts 2005;84(1):S445–S446.
Nossent HC, Swaak TJG (1990) Systemic lupus erythematosus VI. Analysis of the interrelationship with pregnancy. J Rheumatol 17:771–776
Petri M, Howard D, Repke J (1991) Frequency of lupus flare in pregnancy. The Hopkins Lupus Pregnancy Center experience. Arthritis Rheum 34:1538–1545
Moroni G, Quaglini S, Banfi G et al (2002) Pregnancy in lupus nephritis. Am J Kidney Dis 40:713–720
Cervera R, Font J, Carmona F, Balasch J (2002) Pregnancy outcome in systemic lupus erythematosus: good news for the new millennium. Autoimmunity Reviews 1:354–359
Tandon A, Ibanez D, Gladman DD, Urowitz MB (2004) The effect of pregnancy on lupus nephritis. Arthritis Rheum 50:3941–3946
Cervera R, Font J, López-Soto A, Casals F et al (1990) Isotype distribution of anticardiolipin antibodies in systemic lupus erythematosus. Prospective analysis of a series of 100 patients. Ann Rheum Dis 49:109–113
Cervera R, Piette JC, Font J et al (2002) Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1000 patients. Arthritis Rheum 46:1019–1027
Ticani A, Rebaioli CB, Frassi M et al (2005) Pregnancy and autoimmunity: maternal treatment and maternal disease influence on pregnancy outcome. Autoimmunity Reviews 4:423–428
Silveira LH, Hubble CL, Jara LJ et al (1992) Prevention of anticardiolipin antibody-related pregnancy losses with prednisone and aspirin. Am J Med 93:403–411
Khanna D, McMahon M, Furst DE (2004) Safety of tumor necrosis factor-alpha antagonists. Drug Saf 27:307–324
Meyer O (2004) Making pregnancy safer for patients with lupus. Jt Bone Spine 71:178–182
Petri M, Howard D, Repke J et al (1992) The Hopkins Lupus Pregnancy Center: 1987–1991 update. Am J Reprod Immunol 28:188–191
Lockshin M, Reinitz E, Druzin ML et al (1984) Lupus pregnancy: a case–control prospective study demonstrating absence of lupus exacerbations during or after pregnancy. Am J Med 77:893–889
Brucato A, Frassi M, Franceschini F et al (2001) Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectophoresis: a prospective study of 100 women. Arthritis Rheum 44:1832–1835
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725
Bombardier C, Gladman DD, Urowitz MB et al (1992) Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 35:630–40
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Carvalheiras, G., Vita, P., Marta, S. et al. Pregnancy and Systemic Lupus Erythematosus: Review of Clinical Features and Outcome of 51 Pregnancies at a Single Institution. Clinic Rev Allerg Immunol 38, 302–306 (2010). https://doi.org/10.1007/s12016-009-8161-y
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DOI: https://doi.org/10.1007/s12016-009-8161-y