European Journal of Obstetrics & Gynecology and Reproductive Biology
Original ArticleObstetrical outcome of pregnancy in patients with systemic Lupus Erythematosus. A study of 60 cases
Introduction
Interest in the association of autoimmune conditions with pregnancy complications has grown tremendously in the past decade. It is well established that women with certain autoimmune conditions have a high frequency of fetal wastage [1]. It is also well known the association of the antiphospholipid antibodies (aPL), namely the lupus anticoagulant (LA) and anticardiolipin autoantibodies (aCL), with recurrent fetal losses [2], [3], [4], [5], [6].
Systemic lupus erythematosus (SLE) is the autoimmune disease that most frequently compromises pregnancy [1], [2]. The coexistence of SLE and pregnancy is by no means a rare event, as SLE has a predilection for women of childbearing age. Maternal morbidity may be severe during an SLE exacerbation, and treatment itself is limited by pregnancy. On the other hand, active SLE places the embryo, fetus and neonate at enormous risk [2], [3].
However, there is no agreement on the exact influence of pregnancy in the course of SLE and the complexities of the association of SLE and pregnancy have led to a call for a team approach (internists–gynaecologists) undertaking prospective studies [2]. This article summarises maternal and fetal outcome in the first 60 pregnancies in 46 SLE patients followed in our lupus pregnancy clinic, according to a careful multidisciplinary treatment schedule.
Section snippets
Patients
Between January, 1985 and December, 1996 we prospectively followed 60 consecutive pregnancies (including one twin pregnancy) in 46 SLE patients, diagnosed according to the 1982 revised criteria of the American Rheumatism Association [4].
Medical management
At the time of pregnancy diagnosis, a complete physical examination was done and visits were scheduled monthly (or more often when necessary) until the 26th week; from 27th to 35th weeks, patients were scheduled fortnightly and then, weekly until delivery. After
Patient characteristics
The mean (S.D.) age of our patients was 28.6 (4.8) years and the mean (S.D.) duration of SLE was 6.25 (4.85) years. In two cases (3.3%) SLE was diagnosed during pregnancy. Although patients were advised to become pregnant only when the disease was inactive, the disease was considered active at conception in four pregnancies (6.7%) and at that time nine patients (15%) were taking prednisone. Anti Ro (SS-A) antibodies were present in 15 (25%) cases, while 14 out of 46 women (30.4%) tested
Discussion
The topic of pregnancy in women with SLE is at present a matter of great interest, as therapy has helped more patients feel well enough to have families [12], [13]. However, there is no agreement about the exact influence of pregnancy on the course of SLE. Thus, several prospective and retrospective recent studies [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], including some reports using a matched-non pregnant control design [14], [17], [18], [19], [20], [21], [22],
Condensation
Pregnancy in patients with SLE should not be regarded as an unacceptable high-risk condition provided that conception is accurately planned and patients are managed according to a careful multidisciplinary treatment schedule.
Acknowledgments
This work was supported in part by Grants FISS 94/0564 and FISS 94/0323 from Fondo de Investigaciones Sanitarias de la Seguridad Social of Spain.
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