Rheumatology International

, Volume 30, Issue 12, pp 1581–1585 | Cite as

A comparative study of pregnancy outcomes and menstrual irregularities in northern Indian patients with systemic lupus erythematosus and rheumatoid arthritis

  • R. GuptaEmail author
  • S. Deepanjali
  • A. Kumar
  • V. Dadhwal
  • S. K. Agarwal
  • R. M. Pandey
  • P. K. Chaturvedi
Original Article


Systemic lupus erythematosus (SLE) can affect the menstruation, fertility, and pregnancy outcomes of the affected subjects. There is very little data on this aspect of the disease in Indian patients. Our aim was to study the menstrual, fertility, and pregnancy outcomes in these patients in comparison with patients of rheumatoid arthritis (RA) and also to study the effect of cyclophosphamide therapy on menstrual cycles in patients with SLE. Four hundred and twenty patients of SLE (210) and RA (210) were interviewed using a standard questionnaire and available medical records used. After disease-onset, the chances of adverse pregnancy outcomes were significantly more in patients with SLE compared to RA [OR = 5.17 (2.13–12.52); p ≤ 0.001]. Compared to the National average in India, the average number of living children is lesser in patients with RA (2.39 ± 1.39, p = 0.002), but more so in patients with SLE (1.44 ± 1.35, p = 0.001). A younger age at diagnosis and cyclophosphamide therapy was found to be independently associated with menstrual irregularities after disease-onset. We conclude that pregnancy outcome in patients with SLE in India is worse in comparison to patients with RA. Average family size of patients with SLE and RA is less when compared to National average in India. Patients with SLE are more prone for menstrual irregularities, especially those who receive cyclophosphamide treatment.


Pregnancy SLE RA Cyclophosphamide 


  1. 1.
    Clowse ME (2007) Lupus activity in pregnancy. Rheum Dis Clin N Am 33:237–252CrossRefGoogle Scholar
  2. 2.
    Lima F, Buchanan NM, Khamashta MA, Kerslake S, Hughes GR (1995) Obstetric outcome in systemic lupus erythematosus. Semin Arthritis Rheum 25:184–192CrossRefPubMedGoogle Scholar
  3. 3.
    Carmona F, Font J, Cervera R, Munoz F, Cararach V, Balasch J (1999) Obstetrical outcome of pregnancy in patients with systemic lupus erythematosus. A study of 60 cases. Eur J Obstet Gynecol Reprod Biol 83:137–142CrossRefPubMedGoogle Scholar
  4. 4.
    Gonzalez-Crespo MR, Gomez-Reino JJ, Merino R, Ciruelo E, Gomez-Reino FJ, Muley R et al (1995) Menstrual disorders in girls with systemic lupus erythematosus treated with cyclophosphamide. Br J Rheumatol 34:737–741CrossRefPubMedGoogle Scholar
  5. 5.
    Huong DL, Amoura Z, Duhaut P, Sbai A, Costedoat N, Wechsler B et al (2002) Risk of ovarian failure and fertility after intravenous cyclophosphamide. A study in 84 patients. J Rheumatol 29:2571–2576PubMedGoogle Scholar
  6. 6.
    Katsifis GE, Tzioufas AG (2004) Ovarian failure in systemic lupus erythematosus patients treated with pulsed intravenous cyclophosphamide. Lupus 13:673–678CrossRefPubMedGoogle Scholar
  7. 7.
    Chandran V, Aggarwal A, Misra R (2005) Active disease during pregnancy is associated with poor foetal outcome in Indian patients with systemic lupus erythematosus. Rheumatol Int 26:152–156CrossRefPubMedGoogle Scholar
  8. 8.
    Aggarwal N, Sawhney H, Vasishta K, Chopra S, Bambery P (1999) Pregnancy in patients with systemic lupus erythematosus. Aust NZ J Obstet Gynaecol 39:28–30CrossRefGoogle Scholar
  9. 9.
    Gupta A, Agarwal A, Handa R (2005) Pregnancy in Indian patients with systemic lupus erythematosus. Lupus 14:926–927CrossRefPubMedGoogle Scholar
  10. 10.
    Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725–1734CrossRefPubMedGoogle Scholar
  11. 11.
    Arnett FC, Edworthy SM, Bloch DA, Mc Shane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324CrossRefPubMedGoogle Scholar
  12. 12.
    National Fact Sheet, NFHS-3 (2005–2006) Ministry of Health and Family Welfare. (Accessed 24 November 2007)
  13. 13.
    Khamashta MA, Hughes GRV (1996) Pregnancy in systemic lupus erythematosus. Curr Opin Rheumatol 8:424–429CrossRefPubMedGoogle Scholar
  14. 14.
    Kaufman RL, Kitridou RC (1982) Pregnancy in mixed connective tissue disease: comparison with systemic lupus erythematosus. J Rheumatol 9:549–555PubMedGoogle Scholar
  15. 15.
    Nossent HC, Swaak TJ (1990) Systemic lupus erythematosus. VI. Analysis of the interrelationship with pregnancy. J Rheumatol 17:771–776PubMedGoogle Scholar
  16. 16.
    Hardy CJ, Palmer BP, Morton SJ, Muir KR, Powell RJ (1999) Pregnancy outcome and family size in systemic lupus erythematosus: a case–control study. Rheumatology Oxford 38:559–563CrossRefPubMedGoogle Scholar
  17. 17.
    Del Junco DJ, Annegers JF, Coulam CB, Luthra HS (1989) The relationship between rheumatoid arthritis and reproductive function. Br J Rheumatol 28(Suppl):1–33 discussion 42–45Google Scholar
  18. 18.
    Nelson JL, Koepsell TD, Dugowson CE, Voigt LF, Daling JR, Hansen JA (1993) Fecundity before disease onset in women with rheumatoid arthritis. Arthritis Rheum 36:7–14CrossRefPubMedGoogle Scholar
  19. 19.
    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 Oxford 41:643–650CrossRefPubMedGoogle Scholar
  20. 20.
    Clowse ME, Magder LS, Witter F, Petri M (2005) The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum 52:514–521CrossRefPubMedGoogle Scholar
  21. 21.
    Boumpas DT, Austin HA, Vaughan EM, Yarboro CH, Klippel JH, Balow JE (1993) Risk for sustained amenorrhea in patients with Systemic Lupus Erythematosus receiving intermittent pulse cyclophosphamide therapy. Ann Intern Med 119:366–369PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • R. Gupta
    • 1
    Email author
  • S. Deepanjali
    • 1
  • A. Kumar
    • 1
  • V. Dadhwal
    • 2
  • S. K. Agarwal
    • 3
  • R. M. Pandey
    • 4
  • P. K. Chaturvedi
    • 5
  1. 1.Clinical Immunology and Rheumatology Services, Department of MedicineAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of Obstetrics and GynecologyAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of NephrologyAll India Institute of Medical SciencesNew DelhiIndia
  4. 4.Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia
  5. 5.Department of Reproductive BiologyAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations