Pregnancy outcomes in patients with systemic lupus erythematosus: a retrospective review of 62 pregnancies at a single tertiary center in South Korea

Eun-Jung Park, Hyemin Jung, Jiwon Hwang, Hyungjin Kim, Jaejoon Lee, Joong Kyong Ahn, Hoon-Suk Cha, Eun-Mi Koh
International Journal of Rheumatic Diseases 2014, 17 (8): 887-97

OBJECTIVES: To evaluates the pregnancy outcomes in systemic lupus erythematosus (SLE) patients in South Korea and determine the predictive factors for adverse fetal and maternal outcomes.

METHODS: All pregnancies in SLE patients who were seen at the Samsung Medical Center between November 1994 and December 2010 were included and retrospectively analyzed. SLE flares were determined by the Lupus Activity Index-Pregnancy (LAI-P) score.

RESULTS: Sixty-two pregnancies were observed in 50 patients. Fifty-one (82.3%) live births and 11 (17.7%) fetal losses were observed. Thirty-eight of the live births (74.5%) were full-term and 13 (25.5%) were preterm births. Fetal losses included three spontaneous abortions, two stillbirths and six therapeutic abortions. Proteinuria during pregnancy was a predictive factor for adverse fetal outcomes (adjusted odds ratio [OR] 12.50; P = 0.032). An LAI-P score was obtained in 36 pregnancies, and SLE flares occurred in 12 pregnancies (33.3%), primarily during the second trimester (46.2%). Renal involvement (69.2%) was the most common SLE flare during pregnancy. All flares were classified as severe flare according to LAI-P scores. SLE flares during pregnancy were strongly affected by proteinuria prior to pregnancy (adjusted OR 30.28; P = 0.024) and the presence of antiphospholipid antibodies (adjusted OR 6.62; P = 0.047).

CONCLUSION: Our study demonstrated a rate of live births and of flares in pregnant lupus patients comparable to recent reports in Western countries. Proteinuria during and prior to pregnancy and presence of antiphospholipid antibodies were predictive factors for poor pregnancy outcome. Preserved renal function prior to pregnancy resulted in favorable outcomes even in patients with a history of lupus nephritis.

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