The course of pregnancy in female patients with systemic lupus erythematosus

Czech version

Authors: D. Tegzová; K. Andělová
Authors‘ workplace: ÚPMD, Praha ; Revmatologický ústav, Praha
Published in: Čes. Revmatol., 21, 2013, No. 2, p. 72-80.
Category: Original Papers

Overview

The course of pregnancy and lactation in female patients with systemic lupus erythematosus (SLE) is a risk. The risk arises from the disease itself, disease activity, organ involvement, and treatment of the mother prior to conception, during pregnancy and lactation. A flare in the form of skin and joint involvement, leukopenia or renal relapse occurs most commonly. There is also a risk of lupus neonatorum with irreversible AV block type III in the newborns of mothers with positive anti-Ro and anti-La antibodies. There is a higher risk of repeated abortions due to antiphospholipid syndrome (APS). A systemic disease with autoantibodies with prothrombotic and proinflammatory properties can cause a number of complications during pregnancy including a higher number of abortions, increased incidence of preeclampsia, hypertension, growth retardation and premature labour. The immunosuppressive therapy of SLE bears serious risks with respect to pregnancy, as well. Coordinated treatment that should be initiated prior to pregnancy by choosing the right birth control and planning the conception during a period, when the disease is under control or completely in remission, is essential for monitoring of pregnant patients with SLE at risk. A long-time research of pregnancies in SLE at risk is ongoing in the Institute of Rheumatology in cooperation with ÚPMD in Prague-Podolí.

Objectives:
The aim of monitoring within the last two years was to evaluate the course of pregnancy in 44 women with SLE and to monitor the development of selected clinical and laboratory parameters.

Methods:
We evaluated the clinical condition, the overall activity of SLE according to SLEDAI score, therapy during pregnancy and selected hematological, biochemical and immunological parameters. Patients underwent an examination before conception, as well as during early pregnancy, then after each trimester of pregnancy and immediately after labour. The occurrence of the following complications of pregnancy was monitored: SLE flare, the emergence of gestational diabetes, hypertension, preeclampsia, fetal growth disorders, the incidence of neonatal lupus and congenital defects.

Results:
Most patients with SLE were treated with low-dose glucocorticoids, and patients with APS were treated with antiplatelet therapy with a low dose acetylsalicylic acid, and low molecular weight heparin during pregnancy. The total activity of SLE was low in the majority of patients, as expressed by a low value of SLEDAI score. Organ manifestations of SLE were infrequent. 17 women gave birth by Caesarean section. The number of births of full-term newborns after 37th week was 25. The average birth weight was 2860 g, ie lower than the weight of normal population. In 6 female patients, there were signs of late growth retardation. Mothers of these children were more frequently treated for hypertension and also had persistent proteinuria during pregnancy. Hypertension was the most common complication during pregnancy. Only one female patient developed pre-eclampsia, which was an indication for termination of pregnancy. Gestational diabetes was diagnosed in 6 patients, all of which were treated with long-term glucocorticoids. The incidence of gestational diabetes was independent of the dose of glucocorticoids and its occurrence was higher than in the healthy population. Interestingly, we observed a high number of female patients with a concomitant thyroid gland disorder, which, in all cases, turned out to be hypothyroidism treated with thyroid hormone substitution. The most likely explanation is an autoimmune origin in the milieu of increased alert of formation of autoantibodies. We found no congenital defect or neonatal lupus.

Conclusion:
The course of pregnancy was without any complications and without exacerbation of the disease in most female patients with SLE (with/without the presence of secondary APS), which had a low disease activity at conception. The increase in the disease activity of SLE and the presence of organ manifestations during pregnancy were an important predictor of the development of SLE and the whole course of pregnancy in the monitored group.

Key words:
Systemic lupus erythematosus, antiphospholipid syndrome, pregnancy, complication, relapse

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Article was published in

Czech Rheumatology

2013 Issue 2