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Hypertensive disorders of pregnancy associated with adverse pregnant outcomes in patients with systemic lupus erythematosus: a multicenter retrospective study

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Abstract

Background

Hypertension disorders in pregnancy (HDP) were common complications in women with systemic lupus erythematosus (SLE). However, the impact of HDP and the measures to prevent HDP-related fetal adverse pregnancy outcomes (APOs) remained to be explored.

Methods

A multicenter retrospective study of 342 pregnant women with SLE was performed. Variables related to SLE and APOs were recorded. Fetal development was evaluated by umbilical artery Doppler ultrasonography.

Results

HDP was diagnosed in 45 (13.2%) patients, including pre-eclampsia in 42 and gestational hypertension in 3. Patients with HDP had higher incidence of preterm birth (71.1% vs 20.9%, P < 0.001), intrauterine growth retardation (IUGR) (37.8% vs 11.8%, P < 0.001), low-birth-weight infants (62.2% vs 17.2%, P < 0.001), and very-low-birth-weight infants (37.8% vs 2.7%, P < 0.001), compared with lupus patients without HDP. A total of 35 (77.8%) HDP patients had disease activation during pregnancy. All the events occurred during the second and third trimesters, mainly presenting as moderate-to-high activity (65.7%). Active disease [odds ratios (OR) = 3.9, 95% confidential interval (CI) 1.5–9.7, P = 0.004] and positive anticardiolipin (aCL) antibody (OR = 7.6, 95% CI 2.7–18.6, P < 0.001) were independent risk factors for HDP in lupus patients. Doppler RI and S/D ratio predicted APOs in patients with HDP. The optimal cut-off values for RI and S/D ratio were 0.7 (sensitivity 48.1%, specificity 53.3%) and 3.4 (sensitivity 66.7%, specificity 100%), respectively.

Conclusions

HDP was a common pregnant complication and caused various fetal and maternal adverse outcomes in patients with SLE. Umbilical artery Doppler ultrasonography was effective in predicting fetal APOs in lupus patients with HDP.

Key Points

• HDP induced preterm birth, IUGR, low-birth-weight infants, and very-low-birth-weight infants in patients with SLE.

• HDP led to lupus activation during the second and third trimesters.

• Disease activation and aCL positivity were predictors for HDP.

• RI and S/D ratio from umbilical artery Doppler predicted APOs in patients with HDP.

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Author notes

  1. Dongying Chen, Minxi Lao, and Xiaoyan Cai contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, No 58, Zhongshan 2nd Road, Guangzhou, 510080, China

    Dongying Chen, Minxi Lao, Hao Li & Zhongping Zhan

  2. Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Minxi Lao

  3. Department of Rheumatology, Guangzhou First People’s Hospital, Guangzhou, China

    Xiaoyan Cai

  4. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Yanfeng Zhan

  5. Department of Ultrasound, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No 16, Jichang Road, Guangzhou, 510405, China

    Xiaodong Wang

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  1. Dongying Chen
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Correspondence to Xiaodong Wang or Zhongping Zhan.

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This project was supported by grants from the National Natural Science Foundation of China (81601403, 81603435), the Natural Science Foundation of Guangdong Province (2018A0303130294), and the Medical Scientific Research Foundation of Guangdong Province (A2018027).

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Chen, D., Lao, M., Cai, X. et al. Hypertensive disorders of pregnancy associated with adverse pregnant outcomes in patients with systemic lupus erythematosus: a multicenter retrospective study. Clin Rheumatol 38, 3501–3509 (2019). https://doi.org/10.1007/s10067-019-04696-x

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