Fetal outcome and clinical feature during pregnancy in systemic lupus erythematosus / 대한내과학회지

ABSTRACT

BACKGROUN Our aim was to assess the rate of flare in patients with systemic lupus erythematosus (SLE) during pregnancy, to describe fetal outcomes in lupus in Asan Medical Center and to identify clinical or serological factors that would predict pregnancy loss and poor fetal outcome. METHODS: We retrospectively studied 49 pregnancies in 47 women with SLE. Clinical and laboratory data were identified from medical record. RESULTS: Lupus flare occurred in 30 (61.2%) of the pregnancies, mostly in the second trimester. Flares presented most commonly as involvement of skin or joints, constitutional symptoms. All of the patients with flare were treated with glucocorticosteroid. There was no predictive factor for flare of lupus during pregnancy. There were 37 (75.5%) live births and 12 (24.5%) fetal losses. Of live births, 10 (20.4%) were premature babies, 5 (10.2%) intrauterine growth retardation. Of fetal losses, 5 (10.2%) were spontaneous abortion, 5 (10.2%) therapeutic abortion, 2 (4.1%) still births. Using univariate analysis, predictive factors for adverse fetal outcome include antiphospholipid antibody, renal involvement, active lupus at conception and flare of lupus during pregnancy. Using multivariate analysis, antiphospholipid antibody was the only significant predictor for fetal loss, and lupus flare during pregnancy was the only significant predictor for poor fetal outcome. CONCLUSION: There was no predictive factor for the flare of lupus during pregnancy. Most lupus pregnancies did well, but there was a higher rate of adverse fetal outcome. Antiphospholipid antibody and flare of lupus during pregnancy were the only important predictors of fetal loss and premature birth, respectively.