Low disease activity key to reducing adverse pregnancy outcomes in women with SLE

Adverse pregnancy outcomes more frequently occur among women with systemic lupus erythematosus (SLE), results of a study have shown. SLE patients are then advised to delay pregnancy until they achieve Lupus Low Disease Activity State (LLDAS) and to closely monitor pregnancies with the lowest possible dose of corticosteroid (CS).

In this study, the authors collected the medical records of patients with SLE and age-matched controls at Ajou University Hospital. They then compared the clinical features and pregnancy complications in women with SLE to those of the control participants. The predictors of adverse maternal and foetal outcomes were determined through multivariate logistic regression analysis.

A total of 163 pregnancies in patients with SLE and 596 in the general population were analysed. No significant between-group differences were seen in demographic characteristics.

Compared with control participants, women with SLE had a higher rate of stillbirth (odds ratio [OR], 13.2), pre-eclampsia (OR, 4.3), preterm delivery (OR, 2.8), intrauterine growth retardation (OR, 2.5), admission to neonatal intensive care unit (OR, 2.2), and emergency caesarean section (OR, 1.9).

In multivariate regression analysis, the following factors predicted adverse pregnancy outcomes: thrombocytopaenia, low complement, high proteinuria, high SLE Disease Activity Index (SLEDAI), low LLDAS achievement rate, and high CS dose.

In the receiver operating characteristic curve analysis, the optimal cutoff value for the cumulative and mean CS doses were 3,500 and 6 mg, respectively.