Obstetric and Perinatal Outcomes in Pregnant Women with Lupus: Retrospective Study in a Portuguese Tertiary Center

Abstract

Objective Pregnancy in women with lupus poses a higher risk of complications compared with the general population. The present study aimed to determine and describe the obstetric and neonatal outcomes of pregnant women with lupus.

Materials and Methods We conducted an observational retrospective study of pregnant women with the diagnosis of lupus, who were selected and followed at the Maternal-Fetal Medicine Clinic of our institution between January 2013 and July 2018. We analyzed 59 pregnancies and 52 newborns, and collected data regarding sociodemographic features, the preconception period, pregnancy, childbirth, postpartum and the newborn. A descriptive analysis of the variables was performed.

Results In 58% of the cases, the pregnancy was uneventful. We registered flares in 25% of the cases, preeclampsia in 3%, fetal growth restriction in 12%, gestational loss in 10%, preterm labor in 10%, postpartum complications in 20%, and small for gestational age newborns in 17% of the cases.

Conclusions Most pregnancies in women with lupus have favorable obstetric and neonatal outcomes. Prenatal counseling, adequate multidisciplinary surveillance, and optimized treatment of the disease are fundamental pillars for these good results.

Resumo

Objetivo A gravidez em mulheres com lúpus representa um risco maior de complicações em comparação com a população em geral. O presente estudo teve como objetivo determinar e descrever os resultados obstétricos e neonatais de gestantes com lúpus.

Materiais e Métodos Realizamos um estudo retrospectivo observacional de gestantes com diagnóstico de lúpus, selecionadas e acompanhadas no Ambulatório de Medicina Materno-Fetal de nossa instituição entre janeiro de 2013 e julho de 2018. Analisamos 59 gestações e 52 recém-nascidos e coletamos dados referentes às características sociodemográficas, período pré-concepcional, gravidez, parto, pós-parto e nascimento. Foi realizada uma análise descritiva das variáveis.

Resultados Em 58% dos casos, a gravidez transcorreu sem intercorrências. Registramos surtos em 25% dos casos, pré-eclâmpsia em 3%, restrição do crescimento fetal em 12%, perda gestacional em 10%, trabalho de parto prematuro em 10%, complicações pós-parto em 20% e recém-nascidos pequenos para a idade gestacional em 17% dos casos.

Conclusões A maioria das gestações em mulheres com lúpus tem resultados obstétricos e neonatais favoráveis. Aconselhamento pré-natal, vigilância multidisciplinar adequada e tratamento otimizado da doença são pilares fundamentais para esses bons resultados.

Keywords

lupus erythematosus - pregnancy - pregnancy outcome - neonatal systemic lupus erythematosus - Resumo

Palavras-chave

lúpus eritematoso - gravidez - resultado da gravidez - lúpus eritematoso sistêmico neonatal

Contributions

All the authors contributed equally to the present paper, namely to the conception and design, data collection or analysis, interpretation of data, writing of the article, and review of the intellectual content. Therefore, all authors approved the final version to be published.

Publikationsverlauf

Eingereicht: 11. April 2022

Angenommen: 24. April 2023

Artikel online veröffentlicht:
09. November 2023

• References

• 1 Berghella V. Maternal-Fetal Evidence Based Guidelines. Third edition. Boca Raton: CRC Press, Taylor & Francis Group; 2017. . 246–253
• 2 Clark CA, Spitzer KA, Laskin CA. Decrease in pregnancy loss rates in patients with systemic lupus erythematosus over a 40-year period. J Rheumatol 2005; 32 (09) 1709-1712
• 3 Ostensen M, Clowse M. Pathogenesis of pregnancy complications in systemic lupus erythematosus. Curr Opin Rheumatol 2013; 25 (05) 591-596
• 4 Hwang JK, Park HK, Sung YK, Hoh JK, Lee HJ. Maternal outcomes and follow-up of preterm and term neonates born to mothers with systemic lupus erythematosus. J Matern Fetal Neonatal Med 2018; 31 (01) 7-13
• 5 Clowse ME, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 2008; 199 (02) 127.e1-127.e6
• 6 Wallenius M, Salvesen KÅ, Daltveit AK, Skomsvoll JF. Systemic lupus erythematosus and outcomes in first and subsequent births based on data from a national birth registry. Arthritis Care Res (Hoboken) 2014; 66 (11) 1718-1724
• 7 Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: A meta-analysis of studies published between years 2001-2016. J Autoimmun 2017; 79: 17-27
• 8 Borella E, Lojacono A, Gatto M. , Andreoli L, Taglietti M, Iaccarino L, et al. Predictors of maternal and fetal complications in SLE patients: a prospective study. Immunol Res 2014; 60 (2-3): 170-176
• 9 Fischer-Betz R, Specker C. Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome. Best Pract Res Clin Rheumatol 2017; 31 (03) 397-414
• 10 Kim SY, Lee JH. Prognosis of neonates in pregnant women with systemic lupus erythematosus. Yonsei Med J 2008; 49 (04) 515-520
• 11 Iijima S. Fetal and neonatal involvement in maternal rheumatologic disease. J Matern Fetal Neonatal Med 2018; 31 (15) 2079-2085
• 12 Abdwani R, Al Shaqsi L, Al-Zakwani I. Neonatal and Obstetrical Outcomes of Pregnancies in Systemic Lupus Erythematosus. Oman Med J 2018; 33 (01) 15-21
• 13 Teh CL, Wan SA, Cheong YK, Ling GR. Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia. Lupus 2017; 26 (02) 218-223
• 14 Deguchi M, Maesawa Y, Kubota S, Morizane M, Tanimura K, Ebina Y, Yamada H. Factors associated with adverse pregnancy outcomes in women with systematic lupus erythematosus. J Reprod Immunol 2018; 125: 39-44
• 15 Clowse ME, Magder LS, Witter F, Petri M. Early risk factors for pregnancy loss in lupus. Obstet Gynecol 2006; 107 (2 Pt 1): 293-299
• 16 Stojan G, Baer AN. Flares of systemic lupus erythematosus during pregnancy and the puerperium: prevention, diagnosis and management. Expert Rev Clin Immunol 2012; 8 (05) 439-453
• 17 Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D. et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health 2019; 7 (01) e37-e46
• 18 Kroese SJ, Abheiden CNH, Blomjous BS, van Laar JM, Derksen RWHM, Bultink IEM. et al. Maternal and Perinatal Outcome in Women with Systemic Lupus Erythematosus: A Retrospective Bicenter Cohort Study. J Immunol Res 2017; 2017: 8245879
• 19 Nili F, McLeod L, O'Connell C, Sutton E, McMillan D. Maternal and neonatal outcomes in pregnancies complicated by systemic lupus erythematosus: a population-based study. J Obstet Gynaecol Can 2013; 35 (04) 323-328
• 20 Clowse ME, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum 2005; 52 (02) 514-521
• 21 Moroni G, Doria A, Giglio E. , Tani C, Zen M, Strigini F, et al. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century. A prospective multicenter study. J Autoimmun 2016; 74: 6-12
• 22 Bermas BL, Smith NA. . Pregnancy in women with systemic lupus erythematosus [Internet]. UpToDate: [updated 2021 Oct; cited 2021 Nov 28]. Available from: https://www.uptodate.com/contents/pregnancy-in-women-with-systemic-lupus-erythematosus#H452135627
• 23 Chen D, Lao M, Zhang J, Zhan Y, Li W, Cai X, Zhan Z. Fetal and Maternal Outcomes of Planned Pregnancy in Patients with Systemic Lupus Erythematosus: A Retrospective Multicenter Study. J Immunol Res 2018; 2018: 2413637
• 24 Diniz-da-Costa T, Centeno M, Pinto L, Marques A, Mendes-Graça L. Lupus eritematoso sistémico e gravidez. [Systemic lupus erythematosus and pregnancy] Acta Med Port 2012; 25 (06) 448-453
• 25 Moroni G, Doria A, Giglio E, Imbasciati E, Tani C, Zen M. et al. Maternal outcome in pregnant women with lupus nephritis. A prospective multicenter study. J Autoimmun 2016; 74: 194-200
• 26 Lateef A, Petri M. Management of pregnancy in systemic lupus erythematosus. Nat Rev Rheumatol 2012; 8 (12) 710-718
• 27 Cortés-Hernández J, Ordi-Ros J, Paredes F, Casellas M, Castillo F, Vilardell-Tarres M. Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: a prospective study of 103 pregnancies. Rheumatology (Oxford) 2002; 41 (06) 643-650
• 28 Lê Huong D, Wechsler B, Vauthier-Brouzes D, Seebacher J, Lefèbvre G, Blétry O, Darbois Y. et al. Outcome of planned pregnancies in systemic lupus erythematosus: a prospective study on 62 pregnancies. Br J Rheumatol 1997; 36 (07) 772-777
• 29 Clowse ME, Magder L, Witter F, Petri M. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum 2006; 54 (11) 3640-3647
• 30 Yamamoto Y, Aoki S. Systemic lupus erythematosus: strategies to improve pregnancy outcomes. Int J Womens Health 2016; 8: 265-272
• 31 Leroux M, Desveaux C, Parcevaux M, Julliac B, Gouyon JB, Dallay D. et al. Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study. Lupus 2015; 24 (13) 1384-1391
• 32 Clowse ME, Grotegut C. Racial and Ethnic Disparities in the Pregnancies of Women With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2016; 68 (10) 1567-1572