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CC BY 4.0 · Rev Bras Ginecol Obstet 2023; 45(10): e568-e574
DOI: 10.1055/s-0043-1772481
Original Article
High Risk Pregnancy

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

Desfechos obstétricos e perinatais de grávidas com lúpus: Estudo retrospectivo em um centro terciário português
Inês Ferreira Jorge 
1   Serviço de Ginecologia e Obstetrícia, Hospital Beatriz Ângelo, Loures, Portugal
,
Joana Mourão Vieitez Frade 
2   Serviço de Dermatologia, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
,
Susana Paula Leonardo Dias Abreu Capela 
3   Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
,
André Laboreiro Ferreira Mendes da Graça 
3   Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
4   Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
,
Maria Luísa Aleixo Gomes Pinto Grilo 
3   Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
4   Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
,
Ana Mónica Miguel Mendonça de Castro Centeno 
3   Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
4   Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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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.




Publication History

Received: 11 April 2022

Accepted: 24 April 2023

Article published online:
09 November 2023

© 2023. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Berghella V. Maternal-Fetal Evidence Based Guidelines. Third edition. Boca Raton: CRC Press, Taylor & Francis Group; 2017. . 246–253
    CrossrefGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 3 Ostensen M, Clowse M. Pathogenesis of pregnancy complications in systemic lupus erythematosus. Curr Opin Rheumatol 2013; 25 (05) 591-596
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 Fischer-Betz R, Specker C. Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome. Best Pract Res Clin Rheumatol 2017; 31 (03) 397-414
    CrossrefPubMedGoogle Scholar
  • 10 Kim SY, Lee JH. Prognosis of neonates in pregnant women with systemic lupus erythematosus. Yonsei Med J 2008; 49 (04) 515-520
    CrossrefPubMedGoogle Scholar
  • 11 Iijima S. Fetal and neonatal involvement in maternal rheumatologic disease. J Matern Fetal Neonatal Med 2018; 31 (15) 2079-2085
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMed
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 26 Lateef A, Petri M. Management of pregnancy in systemic lupus erythematosus. Nat Rev Rheumatol 2012; 8 (12) 710-718
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 29 Clowse ME, Magder L, Witter F, Petri M. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum 2006; 54 (11) 3640-3647
    CrossrefPubMedGoogle Scholar
  • 30 Yamamoto Y, Aoki S. Systemic lupus erythematosus: strategies to improve pregnancy outcomes. Int J Womens Health 2016; 8: 265-272
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar