PREGNANCY OUTCOME IN SYSTEMIC LUPUS ERYTHEMATOSUS.


Abstract: Objective: To assess the course of maternal disease and outcome of preg­nancy in patients with systemic lupus erythematosus (SLE). Patients and Methods: One hundred SLE patients who carried out 128 pregnancies were studied retrospectively. These patients were followed in lupus unit every one to two months by the rheumatologist and obstetrician team throughout pregnancy. Some patients were given prophylactic low-dose Prednisolone. Lupus flares were treated by increasing Prednisolone doses. Patients who had antiphospholipid antibodies were given Aspirin or Heparin. Results: From 128 pregnancies, there were 71 normal pregnancies (55%), 25 spontaneous abortions (20%), 10 stillbirths (8%), 8 premature (6%) and 14 therapeutic abortions (11%). 19 pregnant had positive anti-Cardiolipin antibodies (aCL). From these 19 patients with positive aCL, 7 cases had normal childbirth (37%), 9 cases had spontaneous abortions (47%), one case had premature and two cases had stillbirths (11%). From 67 pregnancies who had conception during SLE remission, 8 patients (12%) had minor flares, 3 patients (4.5%) had major flares, 8 cases (12%) had major and minor flares but in 29 patients (43) there were no flares. These 67 patients had 42 (63%) normal pregnancies with normal childbirth, 10 (15%) spontaneous abortion, 6 (9%) therapeutic abortion and 3 (4.5%) stillbirth. From 27 pregnancies whose conceptions were during minor organ involvement, 16 women (59%) had minor organ manifestations and 11 (41%) patients developed major organ involvement. In these pregnancies whose conception were during minor organ involvement, there were 11% therapeutic abortions, 16% spontaneous abortions, 11% premature labors, 8% stillbirths, and 54% normal childbirth. From 6 pregnancies whose conceptions were during major organ involvement, 5 cases had therapeutic abortions and in one case there was a stillbirth in the eighth month. From 22 patients who had flares durig pregnancies, 18 cases (81.8%) had kidney involvement, 6 cases (28%) had hematologic manifestations, 4 cases (18%) had pleural effusion. 4 cases (18%) had pericardial effusion, one case had volvular manifestation. and 4 cases (18%) had CNS involvement. Conclusion: 1. SLE flares were relatively common in pregnancy specially when SLE were not in complete remission. 2. Mild relapses such as artic­ular manifestations, dermatologic signs, hematologic disorders and serositis were the most common of flares. 3. There was a higher incidence of fetal complications in SLE pregnant women.