Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies

Abstract

Objective To evaluate the effects of pregnancy in systemic lupus erythematosus (SLE) patients.

Methods The present article is a retrospective cohort study. Data were collected from medical records of pregnant women with SLE from January 2002 to December 2012 at Universidade Estadual de Campinas, in the city of Campinas, state of São Paulo, Brazil. Systemic lupus erythematosus and disease activity were defined according to the American College of Rheumatology and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria respectively. The means, standard deviations (SDs), percentages and correlations were performed using the SAS software, version 9.4 (SAS Institute Inc., Cary, NC, US).

Results We obtained data from 69 pregnancies in 58 women. During pregnancy, a new flare was observed in 39.2% (n = 27). The manifestations were most common in patients with prior kidney disease, and mainly occurred during the third quarter and the puerperium. Renal activity occurred in 24.6% (n = 17), and serious activity, in 16% (n = 11). Of all deliveries, 75% (n = 48) were by cesarean section. Two maternal deaths occurred (3%). Preterm birth was the main complication in the newborns. The abortion rate was 8.7%. Severe SLEDAI during pregnancy was associated with prematurity (100%) and perinatal death (54%).

Conclusion The maternal-fetal outcome is worse in SLE when the women experience a flare during pregnancy. The best maternal-fetal outcomes occur when the disease is in remission for at least 6 months before the pregnancy.

Resumo

Objetivo Avaliar os efeitos da gravidez em pacientes com lúpus eritematoso sistêmico (LES).

Métodos Estudo de coorte retrospectivo. Os dados foram coletados de prontuários de mulheres com LES que engravidaram de janeiro de 2002 a dezembro de 2012 na Universidade Estadual de Campinas, São Paulo, Brasil. Lúpus eritematoso sistêmico e atividade da doença foram definidos segundo o American College of Rheumatology e os critérios do Índice de Atividade da Doença de Lúpus Eritematoso (SLEDAI, na sigla em inglês), respectivamente. As médias, os desvios-padrão (DP), as porcentagens e as correlações foram realizados utilizando o software SAS, versão 9.4 (SAS Institute Inc., Cary, NC, US).

Resultados Obtivemos dados de 69 gestações em 58 mulheres. Durante a gravidez, a reatividade da doença foi observada em 39.2% (n = 27). As manifestações mais comuns foram em pacientes com doença renal prévia, e ocorreram principalmente no terceiro trimestre e no puerpério. Atividade renal ocorreu em 24,6% (n = 17), e atividade grave, em 16% (n = 11). De todos os partos, 75% (n = 48) foram por cesariana. Dois óbitos maternos ocorreram (3%). A prematuridade foi a principal complicação nos recém-nascidos. A taxa de aborto foi de 8,7%. O índice SLEDAI grave durante a gestação foi associado à prematuridade (100%) e à morte perinatal (54%).

Conclusão O resultado materno-fetal é pior no LES quando as mulheres sofrem crise de reativação durante a gravidez. Os melhores desfechos materno-fetais ocorrem quando a doença está em remissão por pelo menos 6 meses anteriores à gestação.

Keywords

systemic lupus erythematosus - pregnancy - obstetric complications - perinatal death

Descritores

lúpus eritematoso sistêmico - gravidez - complicações obstétricas - morte perinatal

Contributors

The idea for the present study and this specific analysis was conceived by Naseri EP, Surita FG, and Costallat LTL. Data collection by Naseri EP and Santos M. All authors were involved in data analysis and interpretation. Naseri EP, Borovac-Pinheiro A and Surita FG wrote the paper. All authors were responsible for the final content.

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