Adverse Maternal and Fetal Outcomes in Lupus - and Pre-Lupus Too Save

A population-based claim study from Sweden has shown that lupus and pre-lupus patients are at risk for adverse maternal and fetal outcomes.   

Investigators used population-based Swedish registers to identify 13,598 women with first singleton pregnancies. They defined cohorts as: SLE as prevalent at delivery; incident within 0–2 years after delivery; and incident 2–5 years after delivery, assuming that this would serve as a proxy for immunologic burden during pregnancy.

They compared maternal and fetal outcomes among 551 patients with prevalent systemic lupus erythematosus (SLE), 65 pre-SLE within 0-2 years and 133 pre-SLE within 2-5 years of diagnosis and 12,847 general population pregnancies.

Overall, adverse maternal outcomes (defined as preeclampsia, hypothyroidism, stroke, and infection) were more common among women with SLE.

For example, preeclampsia was seen in 16% of prevalent-SLE pregnancies vs. 5% in the general population. Preeclampsia was also higher in pre-SLE within 2 years (26%) and pre-SLE withing 2-5 yrs (13%) postpartum.

Fetal adverse outcomes (preterm birth, infection, mortality) were also worse among those born to mothers with prevalent SLE and pre-SLE during pregnancy.

The finding that these adverse outcomes may be seen in those yet to develop SLE suggests immunologic perturbations found prior to a lupus diagnosis may be clinically, if not pathogenically, relevant in such patients.

Avoidance of these pregnancy complications.