Remission or low disease activity at pregnancy onset are linked to improved foetal outcomes in women with systemic lupus erythematosus : results from a prospective observational study
OBJECTIVES: Systemic lupus erythematosus (SLE) patients show variably increased risk for pregnancy complications. We analysed pregnancy outcomes (foetal and maternal), patterns of disease activity and use of medications in a contemporary Caucasian SLE population.
METHODS: Prospective observational study, involving hospital units and private rheumatologists in Greece, of incident pregnancies (period 2015-2018) in women with SLE. Clinical and obstetrical monitoring was performed at regular intervals up to 9 months post-partum. Regression and mixed model analyses were used to determine predictors for adverse foetal outcomes and flares.
RESULTS: We monitored 82 pregnancies in 64 SLE patients. Foetal loss, prematurity and small for gestational age neonate occurred at 15.8%, 34.1% and 8.5%, respectively; 53.7% of pregnancies were complicated with at least one adverse outcome. Patients with antiphospholipid antibodies (aPL) had increased risk (odds ratio [OR] 5.67, p=0.015), whereas those at low disease activity at pregnancy onset were protected (OR 0.20, p=0.024) against foetal complications. Persistent activity and glucocorticoid intake during pregnancy also predicted poor foetal outcomes. SLE patients experienced an average 1.08 mild/moderate and 0.27 severe flares. The latter occurred more frequently post-partum, in patients with alopecia (OR 8.92, p=0.003), hypocomplementaemia (OR 10.34, p=0.038) and nephritis (OR 7.32, p=0.052). Lupusactivity post-labour was paralleled by decreased use of hydroxychloroquine, glucocorticoids and azathioprine.
CONCLUSIONS: In SLE women, foetal complications are common especially in the presence of aPL and increased activity, which corroborates the importance of pregnancy planning and tight disease control at pregnancy onset. Flares, mostly mild or moderate, can occur both during and after pregnancy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:40 |
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| Enthalten in: |
Clinical and experimental rheumatology - 40(2022), 9 vom: 27. Sept., Seite 1769-1778 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ntali, Styliani [VerfasserIn] |
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| Links: |
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| Themen: |
4QWG6N8QKH |
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| Anmerkungen: |
Date Completed 23.09.2022 Date Revised 23.09.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.55563/clinexprheumatol/g4rby6 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM336187041 |
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| 245 | 1 | 0 | |a Remission or low disease activity at pregnancy onset are linked to improved foetal outcomes in women with systemic lupus erythematosus |b results from a prospective observational study |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 23.09.2022 | ||
| 500 | |a Date Revised 23.09.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVES: Systemic lupus erythematosus (SLE) patients show variably increased risk for pregnancy complications. We analysed pregnancy outcomes (foetal and maternal), patterns of disease activity and use of medications in a contemporary Caucasian SLE population | ||
| 520 | |a METHODS: Prospective observational study, involving hospital units and private rheumatologists in Greece, of incident pregnancies (period 2015-2018) in women with SLE. Clinical and obstetrical monitoring was performed at regular intervals up to 9 months post-partum. Regression and mixed model analyses were used to determine predictors for adverse foetal outcomes and flares | ||
| 520 | |a RESULTS: We monitored 82 pregnancies in 64 SLE patients. Foetal loss, prematurity and small for gestational age neonate occurred at 15.8%, 34.1% and 8.5%, respectively; 53.7% of pregnancies were complicated with at least one adverse outcome. Patients with antiphospholipid antibodies (aPL) had increased risk (odds ratio [OR] 5.67, p=0.015), whereas those at low disease activity at pregnancy onset were protected (OR 0.20, p=0.024) against foetal complications. Persistent activity and glucocorticoid intake during pregnancy also predicted poor foetal outcomes. SLE patients experienced an average 1.08 mild/moderate and 0.27 severe flares. The latter occurred more frequently post-partum, in patients with alopecia (OR 8.92, p=0.003), hypocomplementaemia (OR 10.34, p=0.038) and nephritis (OR 7.32, p=0.052). Lupusactivity post-labour was paralleled by decreased use of hydroxychloroquine, glucocorticoids and azathioprine | ||
| 520 | |a CONCLUSIONS: In SLE women, foetal complications are common especially in the presence of aPL and increased activity, which corroborates the importance of pregnancy planning and tight disease control at pregnancy onset. Flares, mostly mild or moderate, can occur both during and after pregnancy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 7 | |a Antibodies, Antiphospholipid |2 NLM | |
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| 700 | 1 | |a Pantazi, Lamprini |e verfasserin |4 aut | |
| 700 | 1 | |a Emmanouilidou, Evgenia |e verfasserin |4 aut | |
| 700 | 1 | |a Papagoras, Charalampos |e verfasserin |4 aut | |
| 700 | 1 | |a Fanouriakis, Antonis |e verfasserin |4 aut | |
| 700 | 1 | |a Dimopoulou, Despoina |e verfasserin |4 aut | |
| 700 | 1 | |a Kallitsakis, Ioannis |e verfasserin |4 aut | |
| 700 | 1 | |a Boki, Kyriaki |e verfasserin |4 aut | |
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| 700 | 1 | |a Sidiropoulos, Prodromos I |e verfasserin |4 aut | |
| 700 | 1 | |a Boumpas, Dimitrios T |e verfasserin |4 aut | |
| 700 | 1 | |a Bertsias, George |e verfasserin |4 aut | |
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