Advertisement

International Urology and Nephrology

, Volume 47, Issue 8, pp 1379–1385 | Cite as

Clinical outcomes and predictors of fetal and maternal consequences of pregnancy in lupus nephritis patients

  • Jiaxuan Lv
  • Wei Wang
  • Yuehong LiEmail author
Nephrology - Original Paper

Abstract

Objective

To define the outcomes and risk predictors of fetal and maternal consequences of pregnancy in lupus nephritis (LN) patients.

Methods

Maternal and fetal outcomes of pregnancy in 52 systemic lupus erythematosus (SLE) patients were observed. Patients were allocated into two groups according to the presence or absence of LN.

Results

LN patients were subject to a higher risk of fetal complications, including fetal loss (7/24, 29.2 %, P = 0.001), lower birth weight (2548.2 ± 540.8 vs. 2949.1 ± 592.6 g, P = 0.028) and a higher frequency of small for gestational age births (33.3 vs. 10.7 %, P = 0.002). Higher rates of lupus flares (83.3 vs. 21.4 %, P = 0.001) and increased LAI-P scores (0.65 ± 0.36 vs. 0.21 ± 0.27, P = 0.001) during pregnancy were observed in LN patients. Multivariate analysis showed that increased SLE activity (P = 0.02, OR 4.2, 95 % CI 1.2–14.5), renal damage (P = 0.001, OR 8.4, 95 % CI 2.2–31.8), hypocomplementemia (P = 0.05, OR 3.23, 95 % CI 1.0–10.7), hypoalbuminemia (P = 0.011, OR 5.62, 95 % CI 1.4–23.0) and hypertension (P = 0.021, OR 6.0, 95 % CI 1.5–24.2) during pregnancy were predictors of adverse fetal outcomes.

Conclusions

Pregnancy in LN patients should be monitored before and during pregnancy because of poor fetal and maternal outcomes. Increased LAI-P scores, renal damage, hypocomplementemia, hypoalbuminemia and hypertension are predictors of adverse fetal outcomes for SLE patients.

Keywords

Systemic lupus erythematosus (SLE) Lupus nephritis (LN) Pregnancy Maternal outcomes Fetal outcome 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Ritchie J, Smyth A, Tower C, Helbert M, Venning M, Garovic V (2012) Maternal deaths in women with lupus nephritis: a review of published evidence. Lupus 21(5):534–541PubMedCrossRefGoogle Scholar
  2. 2.
    Baer AN, Witter FR, Petri M (2011) Lupus and pregnancy. Obstet Gynecol Surv 66(10):639–653PubMedCrossRefGoogle Scholar
  3. 3.
    Vinet E, Labrecque J, Pineau CA, Clarke AE, St-Pierre Y, Platt R et al (2012) A population-based assessment of live births in women with systemic lupus erythematosus. Ann Rheum Dis 71(4):557–559PubMedCrossRefGoogle Scholar
  4. 4.
    Canti V, Castiglioni MT, Rosa S, Franchini S, Sabbadini MG, Manfredi AA et al (2012) Pregnancy outcomes in patients with systemic autoimmunity. Autoimmunity 45(2):169–175PubMedCrossRefGoogle Scholar
  5. 5.
    Bramham K, Hunt BJ, Bewley S, Germain S, Calatayud I, Khamashta MA et al (2011) Pregnancy outcomes in systemic lupus erythematosus with and without previous nephritis. J Rheumatol 38(9):1906–1913PubMedCrossRefGoogle Scholar
  6. 6.
    Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40(9):1725PubMedCrossRefGoogle Scholar
  7. 7.
    Buyon JP, Kalunian KC, Ramsey-Goldman R, Petri MA, Lockshin MD, Ruiz-Irastorza G et al (1999) Assessing disease activity in SLE patients during pregnancy. Lupus 8:677–684PubMedCrossRefGoogle Scholar
  8. 8.
    Stanhope TJ, White WM, Moder KG, Smyth A, Garovic VD (2012) Obstetric nephrology: lupus and lupus nephritis in pregnancy. Clin J Am Soc Nephrol 7(12):2089–2099PubMedCrossRefGoogle Scholar
  9. 9.
    Wagner SJ, Craici I, Reed D, Norby S, Bailey K, Wiste HJ et al (2009) Maternal and foetal outcomes in pregnant patients with active lupus nephritis. Lupus 18(4):342–347PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Bramham K, Soh M, Nelson-Piercy C (2012) Pregnancy and renal outcomes in lupus nephritis: an update and guide to management. Lupus 21:1271–1283PubMedCrossRefGoogle Scholar
  11. 11.
    Smyth Andrew (2010) A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 5:2060–2068PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Shand AW, Algert CS, March L, Roberts CL (2013) Second pregnancy outcomes for women with systemic lupus erythematosus. Ann Rheum Dis 72(4):547–551PubMedCrossRefGoogle Scholar
  13. 13.
    Koh JH, Ko HS, Lee J, Jung SM, Kwok SK, Ju JH, Park SH (2015) Pregnancy and patients with preexisting lupus nephritis: 15 years of experience at a single center in Korea. Lupus 24(7):764–772PubMedCrossRefGoogle Scholar
  14. 14.
    Tang Y, Zhang X, Ji L, Mi X, Liu F, Yang L, Qin W (2015) Clinicopathological and outcome analysis of adult lupus nephritis patients in China. Int Urol Nephrol 47(3):513–520PubMedCrossRefGoogle Scholar
  15. 15.
    Ayodele OE, Okpechi IG, Swanepoel CR (2013) Long-term renal outcome and complications in South Africans with proliferative lupus nephritis. Int Urol Nephrol 45(5):1289–1300PubMedCrossRefGoogle Scholar
  16. 16.
    Hou L, Li G, Zou L, Li C, Chen Y, Yuan Y, Wang X, Jia C, Zhang W (2011) Cesarean delivery rate and indications in mainland China: a cross sectional study in 2011. Zhonghua Fu Chan Ke Za Zhi 49(10):728–735Google Scholar
  17. 17.
    Gladman DD, Tandon A, Ibañez D, Urowitz MB (2010) The effect of lupus nephritis on pregnancy outcome and fetal and maternal complications. J Rheumatol 37(4):754–758PubMedCrossRefGoogle Scholar
  18. 18.
    Saavedra MA, Cruz-Reyes C, Vera-Lastra O, Romero GT, Cruz-Cruz P, Arias-Flores R et al (2012) Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy. Clin Rheumatol 31(5):813–819PubMedCrossRefGoogle Scholar
  19. 19.
    Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD (2010) A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 5(11):2060–2068PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Zhao C, Zhao J, Huang Y et al (2013) New-onset systemic lupus erythematosus during pregnancy. Clin Rheumatol 32(6):815–822PubMedCrossRefGoogle Scholar
  21. 21.
    Fatemi A, Fard RM, Sayedbonakdar Z, Farajzadegan Z, Saber M (2013) The role of lupus nephritis in development of adverse maternal and fetal outcomes during pregnancy. Int J Prev Med 4(9):1004–1010PubMedCentralPubMedGoogle Scholar
  22. 22.
    Imbasciati E, Tincani A, Gregorini G, Doria A, Moroni G, Cabiddu G et al (2009) Pregnancy in women with pre-existing lupus nephritis: predictors of fetal and maternal outcome. Nephrol Dial Transplant 24(2):519–525PubMedCrossRefGoogle Scholar
  23. 23.
    Ko HS, Ahn HY, Jang DG, Choi SK, Park YG, Park IY et al (2011) Pregnancy outcomes and appropriate timing of pregnancy in 183 pregnancies in Korean patients with SLE. Int J Med Sci 8(7):577–583PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Ritchie J, Smyth A, Tower C, Helbert M, Venning M, Garovic V (2012) Maternal deaths in women with lupus nephritis: a review of published evidence. Lupus 21(5):534–541PubMedCrossRefGoogle Scholar
  25. 25.
    Day CJ, Lipkin GW, Savage CO (2009) Lupus nephritis and pregnancy in the 21st century. Nephrol Dial Transplant 24(2):344–347PubMedCrossRefGoogle Scholar
  26. 26.
    Al Arfaj AS, Khalil N (2010) Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus 19(14):1665–1673PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.Department of Nephrology, Beijing Tsinghua Changgung Hospital, Medical CenterTsinghua UniversityBeijingChina

Personalised recommendations