Objective: To evaluate the predictors of maternal and fetal outcome of pregnancy for systemic lupus erythematosus (SLE) patients.
Methods: Ninety-four patients with 96 pregnancies which were evaluated retrospectively from Jan 1990 to Jan 2008 in Peking Union Medical College Hospital were divided into two groups: disease stable during pregnancy (group A) and lupus flares during pregnancy (group B). Statistical analysis was performed by chi(2) or Fisher exact test and Student's t-test. A binary logistic regression model was used to evaluate the predictors of maternal and fetal outcome.
Results: There were 36 pregnancies with stable lupus disease (group A) and 60 pregnancies with lupus flares (group B). Of the 96 pregnancies, 18 resulted in therapeutic abortion and 7 in fetal loss, 71 resulted in a live birth,3 in neonatal death. The rates of preterm delivery, small gestational age (SGA) and neonatal asphyxia in group B were higher than those in group A (P < 0.05). By binary logistic regression analysis, preeclampsia/eclampsia low serum platelet count and SLE flares were associated with poor fetal outcome (beta = 2.463, 2.228, 2.769 respectively, P < 0.05). There were 56 pregnancies with stable lupus disease at the conception with 22 (39.3%) occurred lupus flares during pregnancies. Twenty-four preeclampsia and 2 eclampsia were seen in all the pregnancies. Fifty-two pregnancies were complicated with lupus nephritis, and 25 pregnancies (48.1%, 25/52) of which were disease stable at the conception, and among 22 pregnancies with disease stable over one year, twelve of which occurred lupus nephritis flares. Three pregnancies which have disease activity within one year before pregnancy all occurred lupus nephritis flares. There were four maternal death which all occurred at the postpartum. By binary logistic regression analysis, lupus nephritis flares were associated with preeclampsia/eclampsia (beta = 2.658, P < 0.05), and proteinuria at the conception before delivery were significantly associated with SLE flares (beta = 3.263, P < 0.05).
Conclusion: An increase of fetal loss, preterm delivery, SGA and neonatal asphyxia was seen in patients with lupus flares during pregnancy compared with those with stable disease. About 1/3 lupus activity may increase after pregnancy. Preeclampsia and eclampsia were increased when there were lupus nephritis flares.