Systemic lupus erythematosus (SLE) is a complex chronic multisystem autoimmune inflammatory
disease. SLE most frequently affects women of childbearing age. Women with SLE are
at an increased risk of pregnancy complications that are exacerbated by active disease
associated with a considerable higher risk for fetal and maternal complications.[[1]] These complications include disease activity flares, preeclampsia, preterm birth,
and fetal loss. Several risk factors have been identified to stratify patients with
a high risk for obstetric complications which include anti-SS-A (Ro)/SS-B (La) antibodies
(risk of congenital heart block and neonatal lupus) and patients with an established
diagnosis of antiphospholipid syndrome or lupus nephritis.
In a nationwide analysis of hospitalized pregnant lupus women, it was reported that
there was a noticeable greater improvement in the maternal mortality compared to matched
non-SLE women, which was 34 times higher in 1998–2000 to <5 times higher in 2013–2015.[[2]] This decrease in mortality among women was found to be greater in SLE women than
in those without lupus, suggesting that multiple contributing factors beyond conventional
developments in obstetric care may be responsible. Furthermore, women with SLE had
a greater progress in rates of preeclampsia or eclampsia and length of stay.[[3]] Health-care costs of pregnancy in SLE evaluated in a retrospective observational
analysis from a US health claims database demonstrated a worse outcomes in all measures
compared with non-SLE mother.[[3]]
The rates of SLE-related pregnancies and deliveries have steadily increased over the
last 18 years,[[2]] implying that lupus care has improved through increased awareness of lupus among
the general population and physicians and newer advances in therapies, resulting in
more successful pregnancies and outcomes in SLE patients.
Although knowledge about SLE-related pregnancy risk factors has increased over the
last decade among the general population, obstetricians, and rheumatologists, changes
in outcomes and rates of maternal and fetal mortality, preeclampsia, eclampsia, preterm
birth, and fetal loss are not known in North Africa and the Middle East. Ahmed et
al.[[4]] in the current issue of the journal reported the maternal and fetal outcomes in
pregnant women with SLE and investigated the likely predictors of adverse outcome
of 60 pregnancies in 48 women from Benghazi, Libya, over a 10-year period (2008–2018).
The authors concluded that the characteristics and outcomes in our series are comparable
to those of previously published cohorts internationally. The risk factors identified
in the studied population include preexisting hypertension and secondary APL which
were associated with an increased risk of pregnancy complications.
Despite the small number and the modest investigative details, the contributions made
by Ahmed et al. remain a valuable addition to the literature from this part of the
world.[[4]] The article demonstrated that the outcome of these patients is comparable to that
of studies published earlier from different parts of the world. The optimal use of
traditional therapy with corticosteroids, immunosuppressive drugs, and hydrochloroquine
combined with good antenatal care may have contributed to the good outcome of this
cohort of patients
With the explosion in the use of biologics in rheumatology and other clinical conditions,
more and more physicians are comfortable to use biologics in the management of SLE
in pregnancy driven by the availability of more data about their safety, the success
of these therapies in controlling disease activity, and the increase of remission
rates.[[5]]
Multidisciplinary approach in treating women in the childbearing age with this condition
and similar autoimmune manifestations, who are planning to get pregnant, before conception,
during pregnancy, and their follow-up after pregnancy, will contribute significantly
to optimize their care and will have a profound effect on successful outcomes.[[6]] This should be the platform for a larger prospective study with probably using
different therapeutic modalities including biologics with good safety record in pregnancy.
Author contribution
Equal.
Compliance with ethical principles
Not applicable.
Reviewers:
Not Applicable (Invited)
Editors:
Salem A Beshyah (Abu Dhabi, UAE)
