Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies

Abstract Objective To evaluate the effects of pregnancy in systemic lupus erythematosus (SLE) patients. Methods The present article is a retrospective cohort study. Datawere collected from medical records of pregnant women with SLE from January 2002 to December 2012 at Universidade Estadual de Campinas, in the city of Campinas, state of São Paulo, Brazil. Systemic lupus erythematosus and disease activity were defined according to the American College of Rheumatology and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria respectively. The means, standard deviations (SDs), percentages and correlations were performed using the SAS software, version 9.4 (SAS Institute Inc., Cary, NC, US). Results We obtained data from 69 pregnancies in 58 women. During pregnancy, a new flare was observed in 39.2% (n = 27). The manifestations were most common in patients with prior kidney disease, and mainly occurred during the third quarter and the puerperium. Renal activity occurred in 24.6% (n = 17), and serious activity, in 16% (n = 11). Of all deliveries, 75% (n = 48) were by cesarean section. Twomaternal deaths occurred (3%). Preterm birth was themain complication in the newborns. The abortion rate was 8.7%. Severe SLEDAI during pregnancy was associated with prematurity (100%) and perinatal death (54%). Conclusion Thematernal-fetal outcome is worse in SLE when thewomen experience a flare during pregnancy. The best maternal-fetal outcomes occur when the disease is in remission for at least 6 months before the pregnancy.摘要 研究目的：评估妊娠对系统性红斑狼疮（systemic lupus erythematosus, SLE）患者的影响。研究方法：本研究为回顾性队列研究，数据采集自2002年1月至2012年12月巴西圣保罗州坎皮纳斯市坎皮纳斯州立大学收治的SLE孕妇的医疗记录。系统性红斑狼疮及疾病活动度分别依据美国风湿病学会（American College of Rheumatology）及系统性红斑狼疮疾病活动度指数（Systemic Lupus Erythematosus Disease Activity Index, SLEDAI）的标准进行判定。采用SAS软件9.4版（SAS研究所，美国北卡罗来纳州卡里市）完成均值、标准差（SD）、百分比及相关性统计分析。研究结果：本研究共纳入58例女性患者的69次妊娠数据。妊娠期间，39.2%（n=27）的患者出现疾病新发发作；此类发作多见于既往合并肾脏疾病的患者，且主要发生于妊娠第三期及产褥期。肾脏受累相关的疾病活动占比24.6%（n=17），重度疾病活动占比16.0%（n=11）。所有分娩中，75%（n=48）为剖宫产。共发生2例孕产妇死亡，占比3.0%。早产为新生儿最主要的并发症，整体流产率为8.7%。妊娠期间重度SLEDAI评分与早产（100%）及围产儿死亡（54%）显著相关。研究结论：若系统性红斑狼疮患者于妊娠期间出现疾病发作，则母儿结局更差；若患者于妊娠前至少6个月处于疾病缓解状态，则可获得最佳母儿结局。