Is a Biomarker for Adverse Pregnancy Outcomes on the Horizon? Save

Pregnancy in lupus patients is a complex situation, posing significant concerns for both patients and physicians due to the risk of adverse pregnancy outcomes. These outcomes can range from increased incidences of preeclampsia and eclampsia to significant rises in maternal and fetal mortality. 

About 40-50 years ago, most rheumatologists advised lupus patients against planning pregnancies due to the high risks of mortality and morbidity. However, advancements in recent decades have shifted this perspective. With a better understanding of pathophysiology, improved management guidelines, available medications, and a multidisciplinary approach, pregnancy for lupus patients has become more feasible. Despite these improvements, some patients still experience poor outcomes, highlighting the need for biomarkers that can predict these risks.

An abstract presented at #EULAR2024 (POS1393) explored this possibility by studying six lupus patients, four rheumatoid arthritis (RA) patients, and five healthy pregnancies. This study may be an early indication that biomarkers are on the horizon. The authors compared serum samples from lupus, RA, and healthy controls at various stages: three months before pregnancy, at pregnancy detection, during the third and sixth months of pregnancy, at delivery, and one and three months postpartum. Monocytes were sorted and sequenced from these samples.

The findings revealed that pathways enriched in RA patients were more similar to those in healthy controls, while those in SLE patients were distinct. During SLE pregnancies, there was an upregulation of pathways involving interferon gamma, interleukins 1, 6, and 8, and tumor necrosis factor—pathways that were downregulated in RA and healthy controls. Additionally, microRNAs predicted to control cytokine-mediated signaling pathways and neutrophil activation/degranulation were significantly downregulated in SLE pregnancies.

Thus, SLE pregnancies exhibit a distinct monocyte transcriptomic signature, differing from healthy and RA pregnancies, which is associated with an increased risk of disease flares and adverse pregnancy events. MicroRNAs may contribute to this pro-inflammatory signature and could play a role in future biomarker development.

The need for biomarker development in this high-risk population is imminent. Identifying reliable biomarkers could significantly improve the prognosis and management of pregnancies in lupus patients, ultimately enhancing maternal and fetal outcomes.