Article Figures & Data
Tables
Clinical History Anticoagulant Therapy No thrombosis, miscarriage, or adverse pregnancy outcome Start aspirin 75 mg preconception Previous thrombosis Previous venous events Start aspirin 75 mg and LMWH (enoxaparin 40 mg, dalteparin 5000 IU) as soon as pregnancy confirmed and increase LMWH to BD at 16 weeks Previous arterial events Start aspirin 75 mg and LMWH (enoxaparin 40 mg, dalteparin 5000 IU) twice daily as soon as pregnancy confirmed. Recurrent miscarriage < 10 weeks No anticoagulation Start aspirin 75 mg preconception Miscarriage on aspirin alone Add LMWH OD once pregnancy confirmed. Considered discontinuing LMWH at 20 weeks’ gestation if uterine artery waveform normal Late fetal loss, neonatal death or adverse outcome due to preeclampsia, FGR, or abruption Start aspirin 75 mg preconception. Add LMWH OD once pregnancy confirmed and continue until term. -
LMWH: low molecular weight heparin; FGR: fetal growth restriction.
-
Characteristics No Previous Lupus Nephritis Previous Lupus Nephritis No. pregnancies (no. women) 64 (52) 43 (31) Maternal age, yrs, mean ± SD 32.5 ± 5.3 31.6 ± 5.2 Prepregnancy creatinine, μmol/l n = 38 n = 33 Median (IQR) 63 (55–71) 69* (62–94) Prepregnancy eGFR, ml/min/1.73m2 n = 38 n = 33 Median (IQR) 115 (100–125) 99** (75–122) Prepregnancy eGFR, ml/min/1.73m2 n = 38 n = 33 < 90 8 (21%) 16 (48%)*** < 60 0 4 (12%)**** Body mass index, kg/m2 n = 61 n = 41 Median (IQR) 22.5 (21–27) 22.0 (21–24) Ethnicity, no. (%) White 33 (52) 25 (58) Black 22 (34) 12 (30) Asian 3 (5) 2 (5) Other 6 (9) 4 (9) Autoantibodies, n (%) Anti-Ro/SSA 22 (34) 13 (30) aPL 33 (52) 19 (44) APS, n (%) 12 (19) 10 (23) Obstetric, late pregnancy loss 2 (3) 1 (2) Thrombotic 10 (16) 9 (21) Previous immunosuppression n = 61 n = 41 Cyclophosphamide 4 (7%) 17 (41%)† Mycophenolate mofetil 1 (2%) 7 (17%)†† Current medication, n (%) Aspirin 39 (62) 37 (86)$ LMWH 17 (27) 15 (35) Prednisolone 34 (53) 37 (86)$$ Azathioprine 8 (13) 35 (81)Ω Hydroxychloroquine 35 (55) 20 (47) Nulliparous 39 (61%) 25 (58%) Years since SLE diagnosed, median (IQR) 6 (4–10) 7 (4–13) Active disease at booking 4 (6%) 4 (9%) Proteinuria at booking, + or more 5/60 (8%) 19/40 (48%)¶ Hematuria at booking, + or more 4/60 (7%) 11/40 (28%)¶¶ Blood pressure at booking, mm/hg, median (IQR) Systolic 110 (100–120) 117 (107–130)‡ Diastolic 70 (60–75)‡ 72 (68–80)‡‡ -
↵* p = 0.015,
-
↵** p = 0.051,
-
↵*** p = 0.02,
-
↵**** p = 0.04,
-
↵† p < 0.01,
-
↵†† p < 0.001,
-
↵$ p = 0.008,
-
↵$$ p < 0.0001,
-
↵Ω p = 0.0001,
-
↵‡ p = 0.018,
-
↵‡‡ p = 0.025,
-
↵¶ p < 0.001,
-
↵¶¶ p = 0.008.
-
SLE: systemic lupus erythematosus; IQR: interquartile range; eGFR: estimated glomerular filtration rate; aPL: antiphospholipid antibody; APS: antiphospholipid syndrome; LMWH: low molecular weight heparin.
-
Characteristics No Previous Lupus Nephritis, n = 64 Previous Lupus Nephritis, n = 43 Preeclampsia, n (%) 10 (16) 12 (28) Gestation of preeclampsia onset, weeks, median (range) 37.5 (35–38) 34.5 (32–37)† Mode of delivery, n (%) Caesarean birth 22 (34) 17 (40) Emergency 17 (27) 14 (33) Flare, n (%) 25 (40) 14 (36) Renal flare 1 new (1.5) 6 (14) Time to first flare, weeks Median (range) 22 (16–28) 20 (16–24) Postnatal flare 2 0 Treatment given during flare Prednisolone started 3 0 Prednisolone increased 17 12 Azathioprine increased 0 2 Prednisolone declined 4 0 Hydroxychloroquine started 1 0 No immunosuppression during pregnancy, n (%) 20 (31) 3 (7)†† Bilateral uterine artery notches to predict preeclampsia/SGA 9/58 (16%) 0/40 (0%) Sensitivity 60% 0% Specificity 87% 100% PPV 44% — NPV 85% 47% Postpartum creatinine n = 45 n = 38 Median (IQR) 62 (56–71) 67* (58–94) Postpartum eGFR, ml/min/1.73m2, median (IQR) 105 (94–123) 95** (68–118) Months followup, median (IQR) 39 (23–63) 39 (19–64) - Table 4.
Fetal and neonatal outcome of women with SLE with and without lupus nephritis. Data are n (%) unless otherwise indicated.
Characteristics No Previous Lupus Nephritis, n = 64 Previous Lupus Nephritis (PN), n = 43 Live birth 63 (98) 43 (100) Intrauterine death 1 (1.6) 0 Gestation, weeks Median (IQR) 39.0 (38.3–39.8) 37.9 (34.9–39.3)† Percent < 37/40 7 (11) 13 (30)* Spontaneous 3 (43) 7 (54) Percent < 34/40 2 (3) 8 (19)** Spontaneous 0 (0) 4 (50) Mean birth weight, g, median (IQR) 2990 (2797–3455) 2845 (1980–3300) SGA (< 10th customized centile) 14 (22) 14 (33) Apgar score n = 62 n = 42 < 7 at 1 min 5 (8) 9 (21) < 7 at 5 min 0 1 (2.4) - Table 5.
Factors associated with preeclampsia and preterm delivery in women with SLE with and without lupus nephritis.
Characteristics Preeclampsia, OR (95% CI) < 37 Weeks, OR (95% CI) No Previous Lupus Nephritis, n = 64 Previous Lupus Nephritis, n = 43 No Previous Lupus Nephritis, n = 64 Previous Lupus Nephritis, n = 43 Maternal age, yrs ≤ 35 1.00 1.00 1.00 1.00 > 35 3.55 (0.87–14.13) 2.08 (0.47–9.29) 0.91 (0.17–5.02) 1.78 (0.41–7.80) BMI, kg/m2 ≤ 30 1.0 * * * > 30 10.70 (1.5–75.8) Prepregnancy eGFR, ml/min/1.73m2 ≥ 90 1.00 1.00 * 1.00 < 90 22.5 (1.86–271.95) 12.00 (2.16–66.55) 1.25 (0.27–5.77) Proteinuria at booking Trace or none 1.00 1.00 * 1.00 1 + or more 1.18 (0.12–11.42) 5.7 (1.25–25.92) 4.05 (0.99–16.57) Systolic BP, mmHg at booking ≤ 130 1.00 1.00 1.00 1.00 > 130 2.12 (0.20–23.02) 3.71 (0.83–16.55) 2.94 (0.26–32.97) 5.57 (1.22–25.36) Diastolic BP, mmHg at booking ≤ 80 1.00 1.00 1.00 1.00 > 80 7.29 (1.22–43.41) 4.82 (1.02–22.84) 4.33 (0.65–28.86) 4.06 (0.88–19.86) -
↵* No women in one or more outcome category, therefore OR not calculated. SLE: systemic lupus erythematosus; BMI: body mass index; eGFR: estimated glomerular filtration rate; BP: blood pressure.
-
Clinical Measures No Previous Lupus Nephritis Previous Lupus Nephritis (PN) Prepregnancy creatinine, μmol/l n = 38 n = 33 Median (IQR) 63 (55–71) 69* (62–94) Prepregnancy eGFR, ml/min/1.73m2 n = 38 n = 33 Median (IQR) 115 (100–125) 99** (75–122) Prepregnancy eGFR, ml/min/1.73m2 n = 38 n = 33 < 90 5 (21%) 12 (49%)*** < 60 0 4 (12%) Postpartum creatinine, μmol/l n = 45 n = 38 Median (IQR) 62 (56–71) 67† (58–94) Postpartum eGFR, ml/min/1.73m2 n = 45 n = 38 Median (IQR) 113 (102–124) 105‡ (71–117) Months followup n = 30 n = 31 Median (IQR) 39 (23–63) 39 (19–64) Fall in eGFR n = 13 n = 17 Median (range) 9 (3–38) 11 (2–22) Rate of fall in eGFR, ml/min/1.73m2/month n = 13 n = 17 Median (range) 0.56 (0.06–5.40) 0.29 (0.06–2.26) Fall in eGFR, > 30 ml/min/1.73m2 n = 30 n = 31 No. (%) 2 (6%) 0 (0%)
In this issue
Pregnancy Outcomes in Systemic Lupus Erythematosus with and without Previous Nephritis
