Risk Factors for Poor Pregnancy Outcome in Systemic Lupus Erythematosus Patients

Laniyati Hamijoyo, Januar Wibawa Martha, Syarief Hidayat, Mohammad Rizki Akbar, Henny Tantono, Sylvie Sakasasmita, Kevin Karim, Guntur Darmawan, Sasfia Candrianita, Erica Kwan Yue, Aang Setiawan, Budi Setiabudiawan

Abstract


Background: systemic lupus erythematosus (SLE) is still a challenging autoimmune disease, especially in pregnancy setting. An early risk factors awareness of poor pregnancy outcome is important to optimize the outcome of pregnancy in SLE patients. This study was conducted to describe pregnancy outcome and determine the risk factors associated with poor pregnancy outcome in SLE patients. Methods: a retrospective case-control study of SLE patients with poor and normal pregnancy outcome was performed. Pregnancy histories were reviewed from Dr. Hasan Sadikin General Hospital lupus registry study. The case group was pregnancy with poor outcome, defined as abortion, premature birth, stillbirth, intrauterine growth restriction (IUGR) and neonatal death. The control group was pregnancy with good outcome, defined as live birth and full term. Results: a total of 84 SLE patients were enrolled in this study with 109 pregnancies after SLE diagnosis. The median age of subjects at the time of pregnancy was 28 (25-32) years old. Poor pregnancy outcome comprising 22.9% abortion, 14.7% premature birth, 5.5% stillbirth, 1.8% IUGR and 4.6% neonatal death. There was a significant difference in the number of planned pregnancy (P=0.011) between groups with poor and good outcome. Clinical variables significantly associated with poor pregnancy outcome were lupus nephritis (OR = 4.813, 95% CI 1.709 – 13.557, P = 0.003) and neuropsychiatric SLE (OR = 5.045, 95% CI 1.278 – 19.920, P = 0.021). Conclusion: the pregnancy in SLE patient should be planned to have better outcome. Lupus nephritis and neuropsychiatric (NP) SLE were risk factors for poor pregnancy outcome in SLE patient.

Keywords


systemic lupus erythematosus; pregnancy; poor outcome

References


Hickman RA, Gordon C. Causes and management of infertility in systemic lupus erythematosus. Rheumatology (Oxford). 2011;50(9):1551-8.

Murphy G, Isenberg D. Effect of gender on clinical presentation in systemic lupus erythematosus. Rheumatology (Oxford). 2013;52 (12):2108–15.

Stanhope TJ, White WM, Moder KG, Smyth A, Garovic VD. Obstetric nephrology: lupus and lupus nephritis in pregnancy. CJASN. 2012;7:2089–99.

Kyttaris VC. Systemic lupus erythematosus: from genes to organ damage. Methods Mol Biol. 2010;662:265–83.

Maidhof W, Hilas O. Lupus: An overview of the disease and management options. Pharm Ther. 2012;37(4):240–9.

Lateef A, Petri M. Managing lupus patients during pregnancy. Best practice & research. Clinical Rheumatol. 2013;27(3):10.1016/j.berh.2013.07.005.

Yamamoto Y, Shigeru A. Systemic lupus erythematosus : strategies to improve pregnancy outcomes. 2016;265–72.

Wu J, Ma J, Bao C, Di W, Zhang WH. Pregnancy outcomes among Chinese women with and without systemic lupus erythematosus: a retrospective cohort study. BMJ Open. 2018;8:e020909. doi: 10.1136/bmjopen-2017-020909.

Smyth A, Oliveira GHM, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin. J Am Soc Nephrol. 2010;5(11):2060–8.

Kroese SJ, Abheiden CNH, Blomjous BS, et al. Maternal and perinatal outcome in women with systemic lupus erythematosus: a retrospective bicenter cohort study. J Immunol Res. 2017;1-9.

Clowse MEB, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 2008;199:127.e1-127.e6

Wagner SJ, Craici I, Reed D, et al. Maternal and fetal outcomes in pregnant patients with active lupus nephritis. Lupus. 2009;18(4):342–7.

Chen S, Sun X, Wu B, Lian X. Pregnancy in women with systemic lupus erythematosus: A retrospective study of 83 pregnancies at a single centre. Int J Environ Res Public Health. 2015;12(8):9876–88.

Iozza I, Cianci S, Di Natale A, et al. Update on systemic lupus erythematosus pregnancy. J Prenat Med. 2010; 4(4):67–73.

Hochberg MC. Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725.

Zhan Z, Yang Y, Zhan Y, Chen D, Liang L, Yang X. Fetal outcomes and associated factors of adverse outcomes of pregnancy in southern Chinese women with systemic lupus erythematosus. Colombo GI, editor. PLoS One. 2017;12(4):e0176457.

The American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 102: management of stillbirth. Obstet Gynecol. 2009;113(3):748–61.

The American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol. 2013;121(5):1122–33.

Andrade R, Sanchez ML, Alarcón GS, et al. Adverse pregnancy outcomes in women with systemic lupus erythematosus from a multiethnic US cohort: LUMINA (LVI). Clin Exp Rheumatol. 2008;26(2):268–74.

Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC practice guidelines for the management of arterial hypertension. Blood Press. 2014;23(1):3–16.

ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature. The American Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999;42(4):599–608.

Appel GB, Silva FG, Pirani CL, Meltzer JI, Estes D. Renal involvement in systemic lupud erythematosus (SLE): a study of 56 patients emphasizing histologic classification. Medicine (Baltimore). 1978;57(5):371–410.

Wu J, Di W. Pregnancy outcome in Chinese women with systemic lupus erythematosus: a retrospective study of 255 cases in a single center. Int J Clin Exp Med. 2018;11(2):966–74.

Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:17.

President of Republic of Indonesia. The Constitution of Republic of Indonesia Number 20 Year 2003 about National Education System. 2003: p. 1–33.

Ku M, Guo S, Shang W, et al. Pregnancy outcomes in Chinese patients with systemic lupus erythematosus (SLE): A retrospective study of 109 pregnancies. PLoS One. 2016;11(7):1–10.

Park E-J, Jung H, Hwang J, et al. Pregnancy outcomes in patients with systemic lupus erythematosus: a retrospective review of 62 pregnancies at a single tertiary center in South Korea. Int J Rheum Dis. 2014;17(8):887–97.

Al Arfaj AS, Khalil N. Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus. 2010;19(14):1665–73.

Foocharoen C, Nanagara R, Salang L, Suwannaroj S, Mahakkanukrauh A. Pregnancy and disease outcome in patients with systemic lupus erythematosus (SLE): a study at Srinagarind Hospital. J Med Assoc Thai. 2009;92(2):167–74.

Kwok L-W, Tam L-S, Zhu T, Leung Y-Y, Li E. Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus. Lupus. 2011;20(8):829–36.

Buyon JP, Kim MY, Guerra MM, et al. Predictors of pregnancy outcomes in patients with lupus: A cohort study. Ann Intern Med. 2015;163(3):153–63.

Gluhovschi C, Gluhovschi G, Petrica L, Velciov S, Gluhovschi A. Pregnancy associated with systemic lupus erythematosus: immune tolerance in pregnancy and its deficiency in systemic lupus erythematosus-an immunological dilemma. J Immunol Res. 2015;1-11.

Wu J, Ma J, Zhang W-H, Di W. Management and outcomes of pregnancy with or without lupus nephritis: a systematic review and meta-analysis. Ther Clin Risk Manag. 2018;14:885–901.

de Jesus GR, Rodrigues BC, Lacerda MI, et al. Gestational outcomes in patients with neuropsychiatric systemic lupus erythematosus. Lupus. 2017;26(5):537–42.

El-Sayed YY, Lu EJ, Genovese MC, Lambert RE, Chitkara U, Druzin ML. Central nervous system lupus and pregnancy: 11-year experience at a single center. J Matern Neonatal Med. 2002;12(2):99–103.

De Carolis S, Botta A, Santucci S, et al. Predictors of pregnancy outcome in antiphospholipid syndrome: a review. Clin Rev Allergy Immunol. 2010;38(2–3):116–24.

Di Prima FAF, Valenti O, Hyseni E, et al. Antiphospholipid syndrome during pregnancy: the state of the art. J Prenat Med. 2011;5(2):41–53.

Mammaro A, Carrara S, Cavaliere A, et al. Hypertensive disorders of pregnancy. J Prenatal Med. 2009;3:1–5.

Tian X, Li M, Ye Z, Zhang X, Liu S, Wu L, et al. Related factors of fetal loss in Chinese women with systemic lupus erythematosus: data from Chinese SLE treatment and research group registry IV. Int J Rheum Dis. 2015;18(6):654–60.

Xu X, Liang M, Wang J, Chen S. Clinical features and outcome of pregnancy with SLE-associated thrombocytopenia. J Matern Neonatal Med. 2016;29(5):789–94.


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