Abstract
Systemic lupus erythematosus (SLE) is a disease of reproductive-age women, and thus questions regarding how disease influences pregnancy outcomes arise. We investigated whether five specific types of SLE activity during the 6 months before conception or during pregnancy (nephritis, cytopenias, skin disease, arthritis, serositis) were associated with adverse pregnancy outcomes. We performed a retrospective cohort study of pregnancy outcomes among women with SLE at the Brigham and Women’s Hospital Lupus Center. Adverse pregnancy outcomes included pre-eclampsia, pre-term delivery, elective termination due to SLE, spontaneous miscarriage at weeks 12–20, and stillbirth. SLE and obstetric history, laboratories, and medications were obtained from electronic medical records. Generalized linear mixed models adjusting for potential confounders were used to identify predictors of any adverse pregnancy outcome. Most pregnancies resulted in a live term delivery (76.5 %). After adjustment for Hispanic ethnicity, prior adverse pregnancy outcome and medication use 6 months before conception, nephritis during pregnancy (odds ratio (OR) 3.6, 95 % confidence interval (CI) 1.0–12.8), cytopenias during pregnancy (OR 3.9, 95 % CI 1.3–11.4), and serositis during pregnancy (OR 5.9, 95 % CI 1.0–34.0) were significantly associated with adverse pregnancy outcome. Specific types of SLE disease activity during pregnancy were related to adverse pregnancy outcome. Nephritis, cytopenias, and serositis carried a higher risk of adverse pregnancy outcome, suggesting that these abnormalities should be carefully monitored during pregnancy.
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References
Buyon JP, Kalunian KC, Ramsey-Goldman R et al (1999) Assessing disease activity in SLE patients during pregnancy. Lupus 8(8):677–684
Yee CS, Akil M, Khamashta M et al (2012) The BILAG2004-Pregnancy index is reliable for assessment of disease activity in pregnant SLE patients. Rheumatology (Oxford) 51(10):1877–1880
Ruiz-Irastorza G, Khamashta MA, Gordon C et al (2004) Measuring systemic lupus erythematosus activity during pregnancy: validation of the lupus activity index in pregnancy scale. Arthritis Rheum 51(1):78–82
Buyon JP, Kim MY, Guerra MM et al (2015) Predictors of pregnancy outcomes in patients with lupus: a cohort study. Ann Intern Med 163(3):153–163
Tedeschi SK, Massarotti E, Guan H et al (2015) Specific systemic lupus erythematosus disease manifestations in the six months prior to conception are associated with similar disease manifestations during pregnancy. Lupus 24(12):1283–1292
American College of Rheumatology 1997. Update of the 1982 American College of Rheumatology Revised Criteria for Classification of Systemic Lupus Erythematosus. https://www.rheumatology.org/Practice/Clinical/Classification/SLE/1997_Update_of_Revised_Systemic_Lupus_Erythematosus/. Accessed 7 Mar 2016
Saavedra MA, Cruz-Reyes C, Vera-Lastra O et al (2012) Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy. Clin Rheumatol 31(5):813–819
Kwok LW, Tam LS, Zhu T et al (2011) Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus. Lupus 20(8):829–836
Ko HS, Ahn HY, Jang DG et al (2011) Pregnancy outcomes and appropriate timing of pregnancy in 183 pregnancies in Korean patients with SLE. Int J Med Sci 8(7):577–583
Cavallasca JA, Laborde HA, Ruda-Vega H et al (2008) Maternal and fetal outcomes of 72 pregnancies in Argentine patients with systemic lupus erythematosus (SLE). Clin Rheumatol 27(1):41–46
Al Arfaj AS, Khalil N (2010) Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus 19(14):1665–1673
Andrade R, Sanchez ML, Alarcon GS et al (2008) Adverse pregnancy outcomes in women with systemic lupus erythematosus from a multiethnic US cohort: LUMINA (LVI) [corrected]. Clin Exp Rheumatol 26(2):268–274
Kramer MS, Demissie K, Yang H et al (2000) The contribution of mild and moderate preterm birth to infant mortality. Fetal and infant health study group of the Canadian perinatal surveillance system. JAMA 284(7):843–849
Dooley MA, Aranow C, Ginzler EM (2004) Review of ACR renal criteria in systemic lupus erythematosus. Lupus 13(11):857–860
Branch DWWL (ed) (2014) Normal pregnancy, pregnancy complications and obstetric management. Springer, New York
Clowse ME, Magder L, Witter F et al (2006) Hydroxychloroquine in lupus pregnancy. Arthritis Rheum 54(11):3640–3647
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40(9):1725
Leroux M, Desveaux C, Parcevaux M et al (2015) Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study. Lupus 24(13):1384–1391
Borella E, Lojacono A, Gatto M et al (2014) Predictors of maternal and fetal complications in SLE patients: a prospective study. Immunol Res 60(2–3):170–176
Strauss LT, Gamble SB, Parker WY et al (2006) Abortion surveillance—United States, 2003. MMWR Surveill Summ 55(11):1–32
Acknowledgments
The investigators would like to thank the following funding sources supporting this work: NIH T32 AR007530, K24 AR066109, and R01 AR057327.
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Karen H. Costenbader and Bonnie Bermas are co-senior authors
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Tedeschi, S.K., Guan, H., Fine, A. et al. Organ-specific systemic lupus erythematosus activity during pregnancy is associated with adverse pregnancy outcomes. Clin Rheumatol 35, 1725–1732 (2016). https://doi.org/10.1007/s10067-016-3270-5
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DOI: https://doi.org/10.1007/s10067-016-3270-5