Abstract
Purpose
To determine maternal and fetal outcomes in pregnancies with Systemic Lupus Erythematosus (SLE), and to evaluate the prognostic factors that may affect obstetrical outcomes.
Methods
Sixty-five consecutive cases of SLE and pregnancy were included in this retrospective clinical study, performed in a university hospital which is also a reference center for SLE. Lupus pregnancies followed and delivered during the period from 2002 to 2011 in our department are evaluated. Obstetric outcomes and prognostic factors were main outcome measures.
Results
The mean patient age was 28.8 years and the nulliparity rate was 43.1 %. Disease flare-up occurred in 7.7 % of patients. Lupus anticoagulants, anticardiolipin IgG and IgM antibodies were positive in 27.6, 15.3 and 13.8 % of patients, respectively. Mean gestational age at delivery was 36.6 ± 4.2 and mean birth weight was 2,706 ± 927 g. Stillbirth, fetal growth restriction, preeclampsia and preterm delivery rates were 4.6, 18.5, 9.2 and 27.6 %, respectively. Cases with uterine artery Doppler abnormalities had significantly poorer obstetric outcomes.
Conclusions
Multidisciplinary approach to the care of pregnant women with SLE is mandatory for good maternal and fetal outcomes. Uterine artery Doppler seems to be a good prognostic factor for adverse obstetric outcomes.
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References
D’Cruz DP, Khamashta MA, Hughes GRV (2007) Systemic lupus erythematosus. Lancet 369:587–596
Lawrenz B, Henes J, Henes M, Neunhoeffer E, Schmalzing M, Fehm T et al (2011) Impact of systemic lupus erythematosus on ovarian reserve in premenopausal women: evaluation by using anti-muellerian hormone. Lupus 20:1193–1197
Doria A, Tincani M, Lockshin MD (2008) Challenges of lupus pregnancies. Rheumatology 47(3):9–12
Clowse ME, Jamison M, Myers E, James AH (2008) A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 199(127):e1–e6
Brucato A, Frassi M, Franceschini F, Cimaz R, Faden D, Pisoni MP et al (2001) Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counter immunoelectrophoresis. A prospective study of 100 women. Arthritis Rheum 44:1832–1835
Cortes-Hernandez J, Ordi-Ros J, Paredes F, Casellas M, Castillo F, Vilardell-Tarres M (2002) Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: a prospective study of 103 pregnancies. Rheumatology 41:643–650
Petri M, Howard D, Repke J (1991) Frequency of lupus flare in pregnancy: the hopkins lupus pregnancy center experience. Arthritis Rheum 34:1538–1545
Ruitz-Irastorza G, Lima F, Alves J, Khamashta MA, Simpson J, Hughes GR et al (1996) Increased rate of lupus flare during pregnancy and the puerperium. Br J Rheumatol 35:133–138
Lockshin MD, Reinitz E, Druzin ML, Murrman M, Estes D (1984) Lupus pregnancy: case control prospective study demonstrating absence of lupus exacerbation during or after pregnancy. Am J Med 77:893–898
Urowitz MB, Gladman DD, Farewell VT, Stewart J, McDonald J (1993) Lupus and pregnancy studies. Arthritis Rheum 36:1392–1397
Hochberg MC (1997) Updating the american college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725
Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 4:295–306
Mok CC, Wong RWS (2001) Pregnancy in systemic lupus erythematosus. Postgrad Med J 77:157–165
Mauragani CP, Dafni UG, Tzioufas AG, Moutsopoulos HM (1998) Pregnancy outcome and anti-Ro/SSA in autoimmune disease. A retrospective cohort study. Br J Rheumatol 37:740–745
Georgiou PE, Politi EN, Saka V, Drosos AA (2000) Outcome of lupus pregnancy: a controlled study. Rheumatology 39:1014–1019
Al Arfaj AS, Khalil N (2010) Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus 19:1665–1673
Molad Y, Borkowski T, Monselise A, Ben-Haroush A, Sulkes J, Hod M et al (2005) Maternal and fetal outcome of lupus pregnancy: a prospective study of 29 pregnancies. Lupus 14:145–151
Witter FR, Petri M (2000) Antenatal detection of intrauterine growth restriction in patients with systemic lupus erythematosus. Int Gynaecol Obstet 71:67–68
Chakravarty EF, Colon I, Langen ES, Nix DA, El-Sayed YY, Genovese MC et al (2005) Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. Am J Obstet Gynecol 192:1897–1904
Clowse ME, Magder LS, Witter F, Petri M (2006) Early risk factors for pregnancy loss in lupus. Obstet Gynecol 107:293–299
Whitelaw DA, Hall D, Kotze T (2008) Pregnancy in systemic lupus erythematosus: a retrospective study from a developing community. Clin Rheumatol 27:577–580
Nossent HC, Swaak TJG (1990) Systemic lupus erythematosus VI: analysis of the interrelationship with pregnancy. J Rheumatol 17:771–776
Cavallaca JA, Laborde HA, Ruda-Vega H, Nasswetter GG (2008) Maternal and fetal outcomes of 72 pregnancies in argentine patients with systemic lupus erythematosus (SLE). Clin Rheumatol 27:41–46
Madazli R, Somunkiran A, Calay Z, Ilvan S, Aksu MF (2003) Histomorphology of the placenta and the placental bed of growth restricted foetuses and correlation with the doppler velocimetries of the uterine and umbilical arteries. Placenta 24:510–516
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Madazli, R., Yuksel, M.A., Oncul, M. et al. Obstetric outcomes and prognostic factors of lupus pregnancies. Arch Gynecol Obstet 289, 49–53 (2014). https://doi.org/10.1007/s00404-013-2935-4
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DOI: https://doi.org/10.1007/s00404-013-2935-4