Systemic lupus erythematosus and pregnancy
clinical evolution, maternal and perinatal outcomes and placental findings
Keywords:
Lupus, Pregnancy, Perinatology, Placenta, Maternal welfareAbstract
CONTEXT AND OBJECTIVE: Systemic lupus erythematosus is a chronic disease that is more frequent in women of reproductive age. The relationship between lupus and pregnancy is problematic: maternal and fetal outcomes are worse than in the general population, and the management of fl are-ups is diffi cult during this period. The aim here was to compare the outcomes of 76 pregnancies in 67 women with lupus, according to the occurrence or absence of fl are-ups. DESIGN AND SETTING: An observational cohort clinical study evaluating the evolution of pregnant women with lupus who were receiving care at the prenatal outpatient clinic, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp), between 1995 and 2002. METHODS: Data were collected on a precoded form. The women were divided into two groups according to the occurrence or absence of fl are-ups, as defi ned by the systemic lupus erythematosus disease activity index (SLEDAI). The presence or absence of fl are-ups and renal involvement was considered to be the independent variable and the other results were dependent variables. RESULTS: Flare-ups occurred in 85.3% of cases, and were most signifi cant when there was renal involvement. This was related to greater numbers of women with preeclampsia and poor perinatal outcome. Intrauterine growth restriction was more common in the women with active disease. Placental weight was signifi cantly lower in the women with renal involvement. CONCLUSIONS: Flare-ups and renal involvement in lupus patients during pregnancy are associated with increased maternal and perinatal complications.
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References
Barros VIPVL. Correlações anátomo-clínicas de placentas de pacientes com lúpus eritematoso sistêmico. [Dissertation]. São Paulo: Universidade de São Paulo; 1994.
Khamashta MA, Ruiz-Irastorza G, Hughes GR. Systemic lupus erythematosus flares during pregnancy. Rheum Dis Clin North Am. 1997;23(1):15-30.
Petri M. Hopkins Lupus Pregnancy Center: 1987 to 1996. Rheum Dis Clin North Am. 1997;23(1):1-13.
Kiss E, Bhattoa HP, Bettembuk P, Balogh A, Szegedi G. Pregnancy in women with systemic lupus erythematosus. Eur J Obstet Gynecol Reprod Biol. 2002;101(2):129-34.
Nayar R, Lage JM. Placental changes in a first trimester missed abortion in maternal systemic lupus erythematosus with antiphospholipid syndrome; a case report and review of the literature. Hum Pathol. 1996;27(2):201-6.
Benirschke K, Kauffman P. Lupus erythematosus and lupus anticoagu- lant. In: Benirschke K, Kauffman P, editors. Pathology of the human placenta. 3rd ed. New York: Springer-Verlag; 1995. p. 512-20.
Buyon JP, Tamerius J, Ordorica S, Young B, Abramson SB. Activation of the alternative complement pathway accompanies disease flares in systemic lupus erythematosus during pregnancy. Arthritis Rheum. 1992;35(1):55-61.
Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum. 1992;35(6):630-40.
Lockshin MD. Pregnancy does not cause systemic lupus ery- thematosus to worsen. Arthritis Rheum. 1989;32(6):665-70.
Repke JT. Hypertensive disorders of pregnancy. Differentiating preeclampsia from active systemic lupus erythematosus. J Reprod Med. 1998;43(4):350-4.
Surita FGC, Cecatti JG, Barini R, Parpinelli MA, Silva JLCP. Lúpus e gravidez. Rev Bras Ginecol Obstet. 1997;19(6):413-7.
Dhar JP, Essenmacher LM, Ager JW, Sokol RJ. Pregnancy outcomes before and after a diagnosis of systemic lupus ery- thematosus. Am J Obstet Gynecol. 2005;193(4):1444-55.
Julkunen H. Renal lupus in pregnancy. Scand J Rheumatol Suppl. 1998;107:80-3.
