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Variations of C3 and C4 Before and During Pregnancy in Systemic Lupus Erythematosus: Association With Disease Flares and Obstetric Outcomes.
Crisafulli, Francesca; Andreoli, Laura; Zucchi, Dina; Reggia, Rossella; Gerardi, Maria C; Lini, Daniele; Tani, Chiara; Zatti, Sonia; Franceschini, Franco; Mosca, Marta; Tincani, Angela.
Afiliação
  • Crisafulli F; F. Crisafulli, MD, L. Andreoli, MD, D. Lini, MD, F. Franceschini, MD, A. Tincani, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia; crisafulli.francesca10@gmail.com.
  • Andreoli L; F. Crisafulli, MD, L. Andreoli, MD, D. Lini, MD, F. Franceschini, MD, A. Tincani, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia.
  • Zucchi D; D. Zucchi, MD, C. Tani, MD, M. Mosca, MD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, and Department of Clinical and Experimental Medicine, University of Pisa, Pisa.
  • Reggia R; R. Reggia, MD, Internal Medicine, Casa di Cura San Camillo, Cremona.
  • Gerardi MC; M.C. Gerardi, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, and Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano.
  • Lini D; F. Crisafulli, MD, L. Andreoli, MD, D. Lini, MD, F. Franceschini, MD, A. Tincani, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia.
  • Tani C; D. Zucchi, MD, C. Tani, MD, M. Mosca, MD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, and Department of Clinical and Experimental Medicine, University of Pisa, Pisa.
  • Zatti S; S. Zatti, MD, Obstetrics and Gynecology Unit, Spedali Civili and University of Brescia, Italy.
  • Franceschini F; F. Crisafulli, MD, L. Andreoli, MD, D. Lini, MD, F. Franceschini, MD, A. Tincani, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia.
  • Mosca M; D. Zucchi, MD, C. Tani, MD, M. Mosca, MD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, and Department of Clinical and Experimental Medicine, University of Pisa, Pisa.
  • Tincani A; F. Crisafulli, MD, L. Andreoli, MD, D. Lini, MD, F. Franceschini, MD, A. Tincani, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia.
J Rheumatol ; 50(10): 1296-1301, 2023 10.
Article em En | MEDLINE | ID: mdl-37127323
ABSTRACT

OBJECTIVE:

To analyze complement level variations in systemic lupus erythematosus (SLE) pregnancies, focusing on disease flares and obstetric complications.

METHODS:

SLE pregnancies prospectively followed by multidisciplinary teams from 1987 to 2018 in 2 Italian rheumatology centers were retrospectively analyzed. As reference, pregnancy-modified ranges of normal levels of C3 and C4 were derived from 175 pregnancies from the general obstetric population (GOP), as previously described by our group.

RESULTS:

Two hundred forty-six pregnancies in 172 patients with SLE were analyzed. Eighty-nine percent were live births. Thirty-five flares were recorded in 30 pregnancies (12.2%) and obstetric complications occurred in 47 pregnancies (19.1%) including 27 pregnancy losses, 11 severely preterm births (2 resulting in perinatal death), and 15 hypertensive disorders. C3 and C4 levels were higher in the GOP than in patients with SLE, at any time point. C3 and C4 levels progressively increased during pregnancy in both GOP and SLE pregnancies without flare and obstetric complications, whereas this physiological increase was not observed in pregnancies with flares or obstetric complications. A significantly higher frequency of low C4 was found in pregnancies with flares (at preconception and in each trimester) and preterm births (at preconception). In multivariate analysis, low C4 at preconception was associated with flares (odds ratio 13.81, 95% CI 3.10-61.43, P < 0.001).

CONCLUSION:

Low C4 at preconception was found to be an independent risk factor for SLE flare during pregnancy. Not only C3 and C4 levels but also their variations should be observed, as their failure to increase can be useful to predict risk of complications and suggest closer monitoring.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Complicações na Gravidez / Complemento C3 / Complemento C4 / Nascimento Prematuro / Lúpus Eritematoso Sistêmico Idioma: En Ano de publicação: 2023 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Complicações na Gravidez / Complemento C3 / Complemento C4 / Nascimento Prematuro / Lúpus Eritematoso Sistêmico Idioma: En Ano de publicação: 2023 Tipo de documento: Article