Predictors of Adverse Pregnancy Outcome predictors in Lupus Save
A large metanalysis of systemic lupus erythematosus (SLE) patients and pregnancy outcomes suggests that adverse pregnancy outcomes are more likely in those with lupus nephritis, chronic hypertension, SLE disease activity before and at conception, and secondary antiphospholipid syndrome.
Pregnancies in SLE may be challenging, due to the risk of both maternal SLE flares, maternal pregnancy complications and other adverse pregnancy outcomes (APO).
This systematic review included 355 pregnancies in 8065 women with SLE. Identified APO included:
- Prior lupus nephritis decreased livebirth probability (OR 0·62 [95% CI 0·47–0·81)and an increased risk of preterm birth (2.00 [1·55–2·57), and increased risk of pre-eclampsia (3.11 [2·35–4·12).
- Chronic hypertension increased the risk of disease flare (2.50 [1·74–3·58), preterm birth (2.65 [1·87–3·77]), and pre-eclampsia (5.86 [3·41–10·06]).
- SLE disease activity (conception or preconception) increased risk of preterm birth (2.91 [1·96–4·33]) and pre-eclampsia (2.32 [1·40–3·83])
- Secondary antiphospholipid syndrome decreased livebirth probability (0.40 [0·27–0·58]), and increased risk of pregnancy loss after 20 weeks of gestation (2.77 [1·44–5·31], and increased risk of preterm birth (1·65 [1·29–2·11]).
These findings should factor into preconception counselling to optimize pregnancy outcomes.
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The author has no conflicts of interest to disclose related to this subject
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