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Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Maternal and Fetal Outcomes in Iranian Patients with Systemic Lupus Erythematosus: A Five-Year Retrospective Study of 60 Pregnancies

Author(s): P. Karimzadeh, S. Shenavandeh* and N. Asadi

Volume 15, Issue 4, 2019

Page: [321 - 328] Pages: 8

DOI: 10.2174/1573397115666190125162248

Price: $65

Abstract

Background: As a multisystem autoimmune disease, Systemic Lupus Erythematosus (SLE) mainly affects women during reproductive age. This retrospective study was designed to investigate the fetal and maternal outcomes of Iranian women with SLE.

Methods: Clinical and laboratory records of 60 pregnancies in 55 SLE patients who attended Hafez hospital, a tertiary referral center for high risk pregnancies and SLE patients affiliated with Shiraz University of Medical Science, were reviewed during April 2012 and March 2016.

Results: The mean age of the patients was 29.28±4.6 years and mean disease duration was 5.09±4.2 years. Live birth rate was 83.3% after exclusion of elective abortions. There were 50 live births, 3 neonatal deaths, 3 spontaneous abortions and 7 stillbirths. 9 (15%) women developed preeclampsia and there was 1 (1.6%) case of HELLP syndrome. Lupus flares occurred in 27 (45%) patients during pregnancy. Preterm delivery occurred in 11.6% of pregnancies. Skin and joints were the most frequently affected organs. Patients with previous lupus nephritis (n=18) were associated with a higher risk of maternal complication, but fetal outcomes were similar in both groups. Cesarean rate was about 66%, mostly related to fetal indications (50%).

Conclusion: Pregnancies in most women with pre-existing SLE can now be managed with successful results although presence of previous lupus nephritis is still a major risk factor for adverse maternal outcomes. In our study, fetal outcome was not different between patients with lupus nephritis compared with the patients without nephritis who were under treatments. Hence, to achieve favorable long-term results, we recommend regular multispecialty treatment approaches and progestational counseling for women with SLE.

Keywords: Systemic lupus erythematosus, pregnancy, outcome, lupus flare, Iran, lupus nephritis, hypertension.

[1]
Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD. Manifestations of systemic lupus erythematosus. Maedica (Buchar) 2011; 6(4): 330-6.
[PMID: 22879850]
[2]
Chiu T-F, Chuang Y-W, Lin C-L, et al. Long-term outcomes of systemic lupus erythematous patients after pregnancy: A nationwide population-based cohort study. PLoS One 2016; 11(12)e0167946
[http://dx.doi.org/10.1371/journal.pone.0167946] [PMID: 27992461]
[3]
Khamashta MA, Ruiz-Irastorza G, Hughes GR. Systemic lupus erythematosus flares during pregnancy. Rheum Dis Clin North Am 1997; 23(1): 15-30.
[http://dx.doi.org/10.1016/S0889-857X(05)70312-4] [PMID: 9031372]
[4]
Ruiz-Irastorza G, Khamashta MA. Lupus and pregnancy: ten questions and some answers. Lupus 2008; 17(5): 416-20.
[http://dx.doi.org/10.1177/0961203308090027] [PMID: 18490419]
[5]
Clowse ME. Lupus activity in pregnancy. Rheum Dis Clin North Am 2007; 33(2): 237-52. v.
[http://dx.doi.org/10.1016/j.rdc.2007.01.002] [PMID: 17499705]
[6]
Mintz G, Niz J, Gutierrez G, Garcia-Alonso A, Karchmer S. Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach. J Rheumatol 1986; 13(4): 732-9.
[PMID: 3772921]
[7]
Petri M, Howard D, Repke J. Frequency of lupus flare in pregnancy. The hopkins lupus pregnancy center experience. Arthritis Rheum 1991; 34(12): 1538-45.
[http://dx.doi.org/10.1002/art.1780341210] [PMID: 1670196]
[8]
Doria A, Tincani A, Lockshin M. Challenges of lupus pregnancies. Rheumatology (Oxford) 2008; 47(Suppl. 3): iii9-iii12.
[http://dx.doi.org/10.1093/rheumatology/ken151] [PMID: 18504287]
[9]
Urowitz MB, Gladman DD, Farewell VT, Stewart J, McDonald J. Lupus and pregnancy studies. Arthritis Rheum 1993; 36(10): 1392-7.
[http://dx.doi.org/10.1002/art.1780361011] [PMID: 8216399]
[10]
Tandon A, Ibañez D, Gladman DD, Urowitz MB. The effect of pregnancy on lupus nephritis. Arthritis Rheum 2004; 50(12): 3941-6.
[http://dx.doi.org/10.1002/art.20638] [PMID: 15593212]
[11]
Molad Y, Borkowski T, Monselise A, et al. Maternal and fetal outcome of lupus pregnancy: a prospective study of 29 pregnancies. Lupus 2005; 14(2): 145-51.
[http://dx.doi.org/10.1191/0961203305lu2072oa] [PMID: 15751819]
[12]
Georgiou PE, Politi EN, Katsimbri P, Sakka V, Drosos AA. Outcome of lupus pregnancy: a controlled study. Rheumatology (Oxford) 2000; 39(9): 1014-9.
[http://dx.doi.org/10.1093/rheumatology/39.9.1014] [PMID: 10986308]
[13]
Clowse ME, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum 2005; 52(2): 514-21.
[http://dx.doi.org/10.1002/art.20864] [PMID: 15692988]
[14]
Imbasciati E, Tincani A, Gregorini G, et al. Pregnancy in women with pre-existing lupus nephritis: predictors of fetal and maternal outcome. Nephrol Dial Transplant 2009; 24(2): 519-25.
[http://dx.doi.org/10.1093/ndt/gfn348] [PMID: 18565977]
[15]
Huong DLT, Wechsler B, Vauthier-Brouzes D, Beaufils H, Lefebvre G, Piette JC. Pregnancy in past or present lupus nephritis: a study of 32 pregnancies from a single centre. Ann Rheum Dis 2001; 60(6): 599-604.
[http://dx.doi.org/10.1136/ard.60.6.599] [PMID: 11350849]
[16]
Ko HS, Ahn HY, Jang DG, et al. Pregnancy outcomes and appropriate timing of pregnancy in 183 pregnancies in Korean patients with SLE. Int J Med Sci 2011; 8(7): 577-83.
[http://dx.doi.org/10.7150/ijms.8.577] [PMID: 22022210]
[17]
Andrade R, Sanchez ML, Alarcón GS, et al. LUMINA Study Group. Adverse pregnancy outcomes in women with systemic lupus erythematosus from a multiethnic US cohort: LUMINA (LVI). [corrected] Clin Exp Rheumatol 2008; 26(2): 268-74.
[PMID: 18565248]
[18]
Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 2010. CJN. 00240110
[http://dx.doi.org/10.2215/CJN.00240110] [PMID: 20688887]
[19]
Ku M, Guo S, Shang W, et al. Pregnancy outcomes in Chinese patients with Systemic Lupus Erythematosus (SLE): A retrospective study of 109 pregnancies. PLoS One 2016; 11(7)e0159364
[http://dx.doi.org/10.1371/journal.pone.0159364] [PMID: 27442513]
[20]
Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25(11): 1271-7.
[http://dx.doi.org/10.1002/art.1780251101] [PMID: 7138600]
[21]
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40(9): 1725.
[http://dx.doi.org/10.1002/art.1780400928] [PMID: 9324032]
[22]
Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite Antiphospholipid Syndrome (APS). J Thromb Haemost 2006; 4(2): 295-306.
[http://dx.doi.org/10.1111/j.1538-7836.2006.01753.x] [PMID: 16420554]
[23]
Saavedra MA, Cruz-Reyes C, Vera-Lastra O, et al. Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy. Clin Rheumatol 2012; 31(5): 813-9.
[http://dx.doi.org/10.1007/s10067-012-1941-4] [PMID: 22278163]
[24]
Clowse ME, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 2008; 199(2)127: e1-6.
[http://dx.doi.org/10.1016/j.ajog.2008.03.012] [PMID: 18456233]
[25]
Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum 2006; 54(3): 899-907.
[http://dx.doi.org/10.1002/art.21663] [PMID: 16508972]
[26]
Buyon JP. Dispelling the preconceived notion that lupus pregnancies result in poor outcomes. J Rheumatol 2005; 32(9): 1641-2.
[PMID: 16142853]
[27]
Julkunen H, Jouhikainen T, Kaaja R, et al. Fetal outcome in lupus pregnancy: a retrospective case-control study of 242 pregnancies in 112 patients. Lupus 1993; 2(2): 125-31.
[http://dx.doi.org/10.1177/096120339300200211] [PMID: 8330034]
[28]
Carmona F, Font J, Moga I, et al. Class III-IV proliferative lupus nephritis and pregnancy: a study of 42 cases. Am J Reprod Immunol 2005; 53(4): 182-8.
[http://dx.doi.org/10.1111/j.1600-0897.2005.00263.x] [PMID: 15760379]
[29]
Gladman DD, Tandon A, Ibañez D, Urowitz MB. The effect of lupus nephritis on pregnancy outcome and fetal and maternal complications. J Rheumatol 2010; 37(4): 754-8.
[http://dx.doi.org/10.3899/jrheum.090872] [PMID: 20231194]
[30]
Chakravarty EF, Colón I, Langen ES, et al. Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. Am J Obstet Gynecol 2005; 192(6): 1897-904.
[http://dx.doi.org/10.1016/j.ajog.2005.02.063] [PMID: 15970846]
[31]
Rahman FZ, Rahman J, Al-Suleiman SA, Rahman MS. Pregnancy outcome in lupus nephropathy. Arch Gynecol Obstet 2005; 271(3): 222-6.
[http://dx.doi.org/10.1007/s00404-003-0574-x] [PMID: 15052490]
[32]
Chen CY, Chen YH, Lin HC, Chen SF, Lin HC. Increased risk of adverse pregnancy outcomes for hospitalisation of women with lupus during pregnancy: a nationwide population-based study. Clin Exp Rheumatol 2010; 28(1): 49-55.
[PMID: 20346238]
[33]
Soubassi L, Haidopoulos D, Sindos M, et al. Pregnancy outcome in women with pre-existing lupus nephritis. J Obstet Gynaecol 2004; 24(6): 630-4.
[http://dx.doi.org/10.1080/01443610400007836] [PMID: 16147600]
[34]
Wong K-L, Chan F-Y, Lee C-P. Outcome of pregnancy in patients with systemic lupus erythematosus. A prospective study. Arch Intern Med 1991; 151(2): 269-73.
[http://dx.doi.org/10.1001/archinte.1991.00400020043010] [PMID: 1992954]
[35]
Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Rep 2010; 30: 1-31.
[36]
Paydar K, Niakan Kalhori SR, Akbarian M, Sheikhtaheri A. A clinical decision support system for prediction of pregnancy outcome in pregnant women with systemic lupus erythematosus. Int J Med Inform 2017; 97: 239-46.
[http://dx.doi.org/10.1016/j.ijmedinf.2016.10.018] [PMID: 27919382]
[37]
Liu J, Zhao Y, Song Y, et al. Pregnancy in women with systemic lupus erythematosus: a retrospective study of 111 pregnancies in Chinese women. J Matern Fetal Neonatal Med 2012; 25(3): 261-6.
[http://dx.doi.org/10.3109/14767058.2011.572310] [PMID: 21504337]
[38]
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(6): 643-50.
[http://dx.doi.org/10.1093/rheumatology/41.6.643] [PMID: 12048290]
[39]
Fatemi A, Fard RM, Sayedbonakdar Z, Farajzadegan Z, Saber M. The role of lupus nephritis in development of adverse maternal and fetal outcomes during pregnancy. Int J Prev Med 2013; 4(9): 1004-10.
[PMID: 24130940]
[40]
Lateef A, Petri M. Managing lupus patients during pregnancy. Best Pract Res Clin Rheumatol 2013; 27(3): 435-47.
[http://dx.doi.org/10.1016/j.berh.2013.07.005] [PMID: 24238698]
[41]
Sperber K, Hom C, Chao CP, Shapiro D, Ash J. Systematic review of hydroxychloroquine use in pregnant patients with autoimmune diseases. Pediatr Rheumatol 2009. 13;7:9
[http://dx.doi.org/10.1186/1546-0096-7-9] [PMID: 19439078]
[42]
Levy R, Vilela V, Cataldo M, Ramos R, Duarte JL, Tura B, et al. Hydroxychloroquine (HCQ) in lupus pregnancy: double-blind and placebo-controlled study Lupus 10(6)401-2001; ;
[http://dx.doi.org/10.1191/096120301678646137] [PMID: 11434574]
[43]
Moroni G, Quaglini S, Banfi G, et al. Pregnancy in lupus nephritis. Am J Kidney Dis 2002; 40(4): 713-20.
[http://dx.doi.org/10.1053/ajkd.2002.35678] [PMID: 12324905]
[44]
Wagner SJ, Craici I, Reed D, et al. Maternal and foetal outcomes in pregnant patients with active lupus nephritis. Lupus 2009; 18(4): 342-7.
[http://dx.doi.org/10.1177/0961203308097575] [PMID: 19276302]
[45]
Clark CA, Spitzer KA, Nadler JN, Laskin CA. Preterm deliveries in women with systemic lupus erythematosus. J Rheumatol 2003; 30(10): 2127-32.
[PMID: 14528505]
[46]
Jakobsen IM, Helmig RB, Stengaard-Pedersen K. Maternal and foetal outcomes in pregnant systemic lupus erythematosus patients: an incident cohort from a stable referral population followed during 1990-2010. Scand J Rheumatol 2015; 44(5): 377-84.
[http://dx.doi.org/10.3109/03009742.2015.1013982] [PMID: 26087812]
[47]
Whitelaw DA, Hall D, Kotze T. Pregnancy in systemic lupus erythematosus: a retrospective study from a developing community. Clin Rheumatol 2008; 27(5): 577-80.
[http://dx.doi.org/10.1007/s10067-007-0749-0] [PMID: 17909740]
[48]
Petri M. Prospective study of systemic lupus erythematosus pregnancies. Lupus 2004; 13(9): 688-9.
[http://dx.doi.org/10.1191/0961203303lu2006oa] [PMID: 15485104]
[49]
Lockshin MD, Kim M, Laskin CA, et al. Prediction of adverse pregnancy outcome by the presence of lupus anticoagulant, but not anticardiolipin antibody, in patients with antiphospholipid antibodies. Arthritis Rheum 2012; 64(7): 2311-8.
[http://dx.doi.org/10.1002/art.34402] [PMID: 22275304]
[50]
Sciascia S, Murru V, Sanna G, Roccatello D, Khamashta MA, Bertolaccini ML. Clinical accuracy for diagnosis of antiphospholipid syndrome in systemic lupus erythematosus: evaluation of 23 possible combinations of antiphospholipid antibody specificities. J Thromb Haemost 2012; 10(12): 2512-8.
[http://dx.doi.org/10.1111/jth.12014] [PMID: 23025466]
[51]
Chang J, Streitman D. Physiologic adaptations to pregnancy. Neurol Clin 2012; 30(3): 781-9.
[http://dx.doi.org/10.1016/j.ncl.2012.05.001] [PMID: 22840789]
[52]
Costantine MM. Physiologic and pharmacokinetic changes in pregnancy. Front Pharmacol 2014; 5: 65
[http://dx.doi.org/10.3389/fphar.2014.00065] [PMID: 24772083]
[53]
Zhao C, Zhao J, Huang Y, et al. New-onset systemic lupus erythematosus during pregnancy. Clin Rheumatol 2013; 32(6): 815-22.
[http://dx.doi.org/10.1007/s10067-013-2180-z] [PMID: 23358829]

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