The Analysis Of Pregnant Women With Lupus

We retrospectively, reviewed 60 pregnancies which 47 pregnancies (78%) ended without major maternal or fetal complications, our study showed that spontaneous abortion occurred in 6 pregnancies (10%), other studies such as Eman et al. (11) in their review of 91 pregnancies in Egypt spontaneous abortion was recorded in 15%, another multicenter study conducted by Moroni et al. (12) show incidence of 8.4% in that abortion incidence is between 4% up to 28% (11, 12, 13, 14).

In our study the incidence of preterm labor was 5%, which is much low compared to Eman et al. (11) in which incidence of priority was 13%, other studies show incidence range between 17% to 54% (15,16).

Five pregnancies complicated by pre-eclampsia three of them have preexisting hypertension, (p=0.001), and secondary APL (P=0.005), other retrospective studies reported a wide range of pre-eclampsia incidence 3% to 26% in which hypertension was demonstrated as a significant risk factor (11, 17).

There was no reported SLE flares during pregnancy, on the other hand SLE flare was reported among sixteen patients (26.6%) within three months after delivery, 8 of them (10%) develop nephritis, and one patient developed severe serositis in the form of pericarditis and infective endocarditis.

Although There is still uncertainty about the exact effect of pregnancy on the course of SLE, Several studies showed that pregnancy increased the incidence of SLE flares with rates up to 35% (18,19), while others reported no difference (20). A multicenter prospective trial assessing maternal outcomes of pregnant women with slightly active or inactive lupus nephritis before pregnancy reported that mild-to-moderate disease flares occurred in 18.3% and severe flares in 1.4% of pregnancies(21), these findings were slightly higher than ours mentioned.

Adverse pregnancy outcomes were significantly associated with hypertension and APL Statistically, preexisting HTN was strongly associated with preeclampsia, preterm labor and postnatal SLE flares (p=0.001, 0.003, and 0.004 respectively), while secondary APL was associated with preeclampsia and abortion (p/0.005 and 0.002), older age at pregnancy and active disease before pregnancy was associated with increased risk of postnatal SLE flares (p=0.004), other studies demonstrate that SLE patients with APS had almost two-fold increase in fetal loss when compared to SLE patients with negative APS (22). Although some studies correlated active lupus nephritis and younger maternal age to prematurity (21).

Conclusion

Despite the improvements in pregnancy outcome of SLE pregnant patients, there is still adverse maternal and fetal outcomes. preexisting HTN and secondary APL are associated with increased risk of pregnancy complications. Our data is close to the generally reported in all the previous studies. There need to further reduce risk of lupus during pregnancy by implementing high risk pregnancy clinics to ensure close mointorinng and timely interventions f