Pregnancy in women with systemic lupus erythematosus: a retrospective study of 111 pregnancies in Chinese women.

OBJECTIVE: The impact of pregnancy on lupus activity has been controversial especially in Chinese women. Research looking at predictive factors in this population are sparse. The aim of this study was therefore twofold: to determine the frequencies of abnormal pregnancy outcomes in a Chinese cohort and to identify clinical and laboratory factors predicting adverse fetal and maternal outcomes in Chinese women with systemic lupus erythematosus.

STUDY DESIGN: Data of 111 pregnancies of 105 systemic lupus erythematosus (SLE) patients from January 1990 to December 2008 in Peking Union Medical College Hospital in Beijing were analyzed retrospectively. Univariate analysis using chi-square test and logistic regression was used to assess the predictive value of each variable on binary outcomes. Lupus activity was based on SLE Disease Activity Index (SLEDAI) criteria.

RESULTS: There were 23 elective, 2 spontaneous abortions, and 5 stillbirths, with 81 pregnancies resulting in live births including two multiple gestations. Three neonatal deaths were reported. Fetal loss rate including neonatal death was 11.1%. Fetal loss in active SLE group (17.0%) was significantly higher than those in inactive group (2.0%) (P = 0.047). The incidence of premature birth in active SLE group was 25/47 (53.2%), which is significantly higher than those in inactive group (3/34, 8.8%) (P < 0.001). Small for gestational age (SGA) was more common in active SLE group with incidence of 40.0% compared to 5.6% in inactive group (P < 0.001). Five fetal malformations were recorded (6.0%), including three fetal heart malformations (one complete heart block, one tetralogy of Fallot, and one atrial septal defect) and two multiple fetal malformations, which were significantly higher than general population. Among 25 pregnancies that were in active stage at conception, 14 (56%) deteriorated during pregnancy. Of the 68 pregnancies that were stable at conception, 26 (38%) flared during pregnancy or postpartum. Preeclampsia/eclampsia (OR = 14.83, 95% CI: 3.83-57.41) and thrombocytopenia (OR = 4.43, 95% CI: 1.12-17.60) were significant predictors of fetal loss; preeclampsia/eclampsia (OR = 8.04, 95% CI: 2.00-32.34) and active SLE (OR = 19.90, 95% CI: 2.38-166.27) were significantly associated with preterm birth; preeclampsia/eclampsia (OR = 8.92, 95% CI: 2.25-35.44) and thrombocytopenia (OR = 4.03, 95% CI: 1.24-17.25) were also significant predictors of maternal SLE flare-up.

CONCLUSION: In general, lupus in pregnancy in the Chinese population is generally similar to other cohorts. Pregnancies can be successful in most women with SLE. However, an increase in SLE activity can occur in a significant number of patients, even those who are well controlled. Adverse fetal outcome including fetal loss, preterm birth, and SGA increases significantly with SLE flares during pregnancy with preeclampsia/eclampsia, thrombocytopenia, and active SLE serving independent predictors of adverse fetal and maternal outcome. Fetal echo should not just for heart block but for structural abnromalities as the structural malformation rate was significantly higher than general population, especially congenital heart disease.