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Pregnancy outcome in systemic lupus erythematosus (SLE) is improving: Results from a case control study and literature review.

Yan Yuen S, Krizova A, Ouimet JM, Pope JE - Open Rheumatol J (2008)

Bottom Line: Over time, the rate of SLE peripartum flares has improved (p = 0.002) and the proportion of pregnancies resulting in live birth has increased (p = 0.024).The frequency of fetal death has not significantly changed.However, new strategies with respect to pregnancy timing and multidisciplinary care have improved maternal and fetal outcome in SLE.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, The University of Western Ontario, London, ON, Canada.

ABSTRACT

Objectives: For women who suffer from systemic lupus erythematosus (SLE), pregnancy can be a concern, placing the mother and fetus at risk. Our objectives were to assess the risk of adverse pregnancy outcome, disease flares, fertility rate, and co-morbidities in SLE women compared to healthy controls. We also systematically reviewed the literature available on pregnancy outcome in SLE to compare our results to other published data. Our hypothesis was that pregnancy outcome in SLE is improving over time.

Methods: A case-control study comparing self-report of the above-mentioned parameters in SLE (N=108) vs healthy controls or patients with non-inflammatory musculoskeletal (MSK) disorders (N=134) was performed. Data were collected using a self-administered questionnaire. Proportions, means and odds ratios were calculated. We searched and quantified the literature on pregnancy outcome, lupus reactivation and fertility rate. Data were summarized and presented in mean % ± SEM and median % with interquartile range (IQR).

Results: Gynecological history, fertility rate and age at first pregnancy in SLE patients were comparable to controls. Eighteen percent of SLE patients reported a flare and 18% reported an improvement of symptoms during pregnancy. Twenty-four percent of lupus patients had at least one preterm delivery vs 5% in controls (OR =8.32, p = 0.0008), however other pregnancy outcomes (miscarriage, therapeutic abortion, stillbirth and neonatal death rate) did not differ between the groups. Thyroid problems were reported to be more likely in SLE patients (p = 0.02), but the prevalence of other co-morbidities was similar to controls. A literature review demonstrated that fertility was not affected in SLE patients. Lupus reactivations are common during pregnancy (36.5% ± SEM 3.3%). Most agreed that SLE pregnancies had more fetal loss (19.5% ± SEM 1.6%) and preterm births (25.5% ± SEM 2.2%) when compared to the general population. Over time, the rate of SLE peripartum flares has improved (p = 0.002) and the proportion of pregnancies resulting in live birth has increased (p = 0.024). The frequency of fetal death has not significantly changed. Our findings from the case-control study were, in general, consistent with the literature including the frequency of fetal death, neonatal death, live births and pregnancy rate.

Conclusion: Prematurity (25.5% ± SEM 2.2%) and fetal death (19.5% ± SEM 1.6%) in SLE pregnancy are still a concern. However, new strategies with respect to pregnancy timing and multidisciplinary care have improved maternal and fetal outcome in SLE.

No MeSH data available.


Related in: MedlinePlus

The frequency of SLE peripartum flares in the literature prior to 1990 vs most recent data.
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Figure 1: The frequency of SLE peripartum flares in the literature prior to 1990 vs most recent data.

Mentions: In total, 54 articles on lupus pregnancy published from 1963 to 2006 were reviewed [8-1]. Table 2 presents the results from the previously published studies compared to our present case-control study findings. Most of the results were similar between groups; however, we found that SLE flares (by self report) during pregnancy were less frequent in our population compared to the literature. Also, fewer patients from our study had prematurity or elective termination. Figs. (1,2) show results in median (%) for pregnancy outcome and SLE peripartum flares subdivided into 3 periods of publication date. Each time frame contains data from 18 publications. We noticed that over time, the rate of SLE peripartum flares has improved (p = 0.002), elective abortions (including termination for medical or personal reasons) have decreased, and the proportion of pregnancies resulting in live birth has increased (p = 0.024). The frequency of fetal death (the sum of spontaneous abortions or miscarriage and stillbirths) has not significantly changed. Results in mean (%) and median (%) were similar (Table 3).


Pregnancy outcome in systemic lupus erythematosus (SLE) is improving: Results from a case control study and literature review.

Yan Yuen S, Krizova A, Ouimet JM, Pope JE - Open Rheumatol J (2008)

The frequency of SLE peripartum flares in the literature prior to 1990 vs most recent data.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627535&req=5

Figure 1: The frequency of SLE peripartum flares in the literature prior to 1990 vs most recent data.
Mentions: In total, 54 articles on lupus pregnancy published from 1963 to 2006 were reviewed [8-1]. Table 2 presents the results from the previously published studies compared to our present case-control study findings. Most of the results were similar between groups; however, we found that SLE flares (by self report) during pregnancy were less frequent in our population compared to the literature. Also, fewer patients from our study had prematurity or elective termination. Figs. (1,2) show results in median (%) for pregnancy outcome and SLE peripartum flares subdivided into 3 periods of publication date. Each time frame contains data from 18 publications. We noticed that over time, the rate of SLE peripartum flares has improved (p = 0.002), elective abortions (including termination for medical or personal reasons) have decreased, and the proportion of pregnancies resulting in live birth has increased (p = 0.024). The frequency of fetal death (the sum of spontaneous abortions or miscarriage and stillbirths) has not significantly changed. Results in mean (%) and median (%) were similar (Table 3).

Bottom Line: Over time, the rate of SLE peripartum flares has improved (p = 0.002) and the proportion of pregnancies resulting in live birth has increased (p = 0.024).The frequency of fetal death has not significantly changed.However, new strategies with respect to pregnancy timing and multidisciplinary care have improved maternal and fetal outcome in SLE.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, The University of Western Ontario, London, ON, Canada.

ABSTRACT

Objectives: For women who suffer from systemic lupus erythematosus (SLE), pregnancy can be a concern, placing the mother and fetus at risk. Our objectives were to assess the risk of adverse pregnancy outcome, disease flares, fertility rate, and co-morbidities in SLE women compared to healthy controls. We also systematically reviewed the literature available on pregnancy outcome in SLE to compare our results to other published data. Our hypothesis was that pregnancy outcome in SLE is improving over time.

Methods: A case-control study comparing self-report of the above-mentioned parameters in SLE (N=108) vs healthy controls or patients with non-inflammatory musculoskeletal (MSK) disorders (N=134) was performed. Data were collected using a self-administered questionnaire. Proportions, means and odds ratios were calculated. We searched and quantified the literature on pregnancy outcome, lupus reactivation and fertility rate. Data were summarized and presented in mean % ± SEM and median % with interquartile range (IQR).

Results: Gynecological history, fertility rate and age at first pregnancy in SLE patients were comparable to controls. Eighteen percent of SLE patients reported a flare and 18% reported an improvement of symptoms during pregnancy. Twenty-four percent of lupus patients had at least one preterm delivery vs 5% in controls (OR =8.32, p = 0.0008), however other pregnancy outcomes (miscarriage, therapeutic abortion, stillbirth and neonatal death rate) did not differ between the groups. Thyroid problems were reported to be more likely in SLE patients (p = 0.02), but the prevalence of other co-morbidities was similar to controls. A literature review demonstrated that fertility was not affected in SLE patients. Lupus reactivations are common during pregnancy (36.5% ± SEM 3.3%). Most agreed that SLE pregnancies had more fetal loss (19.5% ± SEM 1.6%) and preterm births (25.5% ± SEM 2.2%) when compared to the general population. Over time, the rate of SLE peripartum flares has improved (p = 0.002) and the proportion of pregnancies resulting in live birth has increased (p = 0.024). The frequency of fetal death has not significantly changed. Our findings from the case-control study were, in general, consistent with the literature including the frequency of fetal death, neonatal death, live births and pregnancy rate.

Conclusion: Prematurity (25.5% ± SEM 2.2%) and fetal death (19.5% ± SEM 1.6%) in SLE pregnancy are still a concern. However, new strategies with respect to pregnancy timing and multidisciplinary care have improved maternal and fetal outcome in SLE.

No MeSH data available.


Related in: MedlinePlus