Obstetric outcome in systemic lupus erythematosus

• Published in: Seminars in arthritis and rheumatism Vol. 25; no. 3; pp. 184 - 192
• Main Authors: Lima, Fernanda, Buchanan, Neil M.M., Khamashta, Munther A., Kerslake, Siân, Hughes, Graham R.V.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.12.1995; Elsevier
• Subjects: Adult; Antibodies, Antiphospholipid - immunology; Biological and medical sciences; Diseases of mother, fetus and pregnancy; Female; Fetal Death - etiology; Gynecology. Andrology. Obstetrics; Humans; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - therapy; Medical sciences; Pregnancy; Pregnancy Complications - immunology; Pregnancy Complications - therapy; Pregnancy Outcome; Pregnancy. Fetus. Placenta; APS; NND; PROM; pregnancy; fetal loss; aCL; NNL; antiphospholipid antibodies; Systemic lupus erythematosus; PNP; TOP; IUGR; LA; CTG; IUD; aPL; CHB; FD; WHO; Human; Immunopathology; Connective tissue disease; Skin disease; Prognosis; Pregnancy disorders; Antiinflammatory agent; Autoimmune disease; Pregnancy; Immunomodulator; Chemotherapy; Newborn; Treatment; Systemic disease; Evolution; Female; Fetus; Lupus erythematosus; Disseminated
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/S0049-0172(95)80030-1

A prospective study was performed to investigate the fetal and maternal outcome of 108 pregnancies in 90 lupus patients. The protocol was based on shared care of the patients by a rheumatologist and an obstetrician, with input from a hematologist, if necessary. Lupus flares were treated with low-dose prednisolone, azathioprine and hydroxychloroquine. The live birth rate was increased from 31% in the patients' previous obstetric history to 82%. A high incidence of prematurity was observed (43%). Lupus patients with secondary antiphospholipid syndrome presented a higher risk for fetal loss ( P = .006). Flares occurred in 57% of the pregnancies, but most were mild (skin and joints). Flare during pregnancy did not increase the risk of fetal loss. We believe that careful monitoring and management of the lupus pregnancy has substantially improved the fetal outcome.