Title: Systemic Lupus Erythematosis and Adverse Pregnancy out Come - A Prospective Study
Authors: C. Jayakumari, Nirmala.C, Shahida J, Sujatha Y
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.140
Abstract
Background: Systemic lupus erythematosus (SLE) is one of the most common autoimmune disorders that affect women during their childbearing years. It is an idiopathic chronic inflammatory disease that affects skin, joints, kidneys, lungs, serous membrane, nervous system, liver and other organs of the body. SLE increases the risk of spontaneous abortion, intrauterine fetal death, preeclampsia, intrauterine growth retardation, and preterm birth
Objective: The Primary objective of the study was to find out the maternal and fetal outcome of SLE complicating pregnancy and diagnosed prior to pregnancy.
Methodology: This study was conducted in the Department of Obstetrics and Gynecology in, S.A.T hospital in Govt. Medical College Trivandrum, Kerala in collaboration with the Department of Medicine. This was a prospective follow up study. 36 pregnant women were recruited based on diagnosis of SLE prior to pregnancy.
Results: SLE is associated with high proportion of maternal and fetal morbidity and mortality.. 27.8% of cases had preterm labour. There was one case of maternal mortality due to intra cerebral thrombosis. Rate of caesarean section is 56.7%, which is significantly higher than average. IUGR, Intra uterine death and low birth weight were also significantly higher.
Conclusion: We conclude that mother with SLE has a significantly higher risk of obstetric and fetal complication including mortality, in spite of the fact that they were on treatment prior to getting pregnant. Multidisciplinary, tertiary care centres equipped with Obstetric critical care unit is essential to improve outcomes.
Keywords: SLE, Pregnancy outcome, IUGR, Pre eclampsia , fetal outcomes.
References
1. Cooper G, Bynum M, Somers E (2009) Recent insights in the epidemic - ology of autoimmune diseases: improved preval-ence estimates and understanding of clustering of diseases. J Autoimmun 33(3–4):197–207
2. Hurt KJ, Guile MW, Bienstock JL, Fox HE, Wallach EE (2011) The Johns Hop-kins manual of gynecology and obstetrics. Lippincott Williams and Wilkins
3. Chen CY, Chen YH, Lin HC, Chen SF, Lin HC. Increased risk of adverse pregnancy outcomes for hospitalisation of women with lupus during pregnancy: a nationwide population-based study. Clin Exp Rheumatol. 2010 Jan-Feb. 28(1):49-55.
4. Gladman DD, Tandon A, Ibañez D, Urowitz MB. The effect of lupus nephritis on pregnancy outcome and fetal and maternal complications. J Rheumatology. 2010 Apr. 37(4):754-8.
5. Madazli R, Bulut B, Erenel H, Gezer A, Guralp O. Systemic lupus erythematosus and pregnancy. J Obstet Gynaecol. 2010 Jan;. 30(1):17-20.
6. Motha MB, Wijesinghe PS. Systemic lupus erythematosus and pregnancy--a challenge to the clinician. Ceylon Med J. 2009 Dec;. 54(4):107-9.
7. Smyth A, Garovic VD. Systemic lupus erythematosus and pregnancy. Minerva Urol Nefrol. 2009 Dec;. 61(4):457-74.
8. Moroni G, Quaglini S, Banfi G, et al. Pregnancy in lupus nephritis. Am J Kidney Dis. 2002 Oct. 40(4):713-20..
9. Tandon A, Ibañez D, Gladman DD, Urowitz MB. The effect of pregnancy on lupus nephritis. Arthritis Rheum. 2004 Dec. 50(12):3941-6.
10. Chakravarty EF, Colón I, Langen ES, et al. Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. Am J Obstet Gynecol. 2005 Jun. 192(6):1897-904.
11. Kim MY, Buyon JP, Guerra MM, Rana S, Zhang D, Laskin CA, et al. Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies: results of the PROMISSE study. Am J Obstet Gynecol. 2016 Jan. 214 (1):108.e1-108.e14.
12. Sciascia S, Hunt BJ, Talavera-Garcia E, Lliso G, Khamashta MA, Cuadrado MJ. The impact of hydroxychloroquine treatm-ent on pregnancy outcome in women with antiphospholipid antibodies. Am J Obstet Gynecol. 2016 Feb. 214 (2):273.e1-8.
13. Izmirly PM, Llanos C, Lee LA, Askanase A, Kim MY, Buyon JP. Cutaneous manifestations of neonatal lupus and risk of subsequent congenital heart block. Arthritis Rheum. 2010 Apr;. 62(4):1153-7.
14. Vinet É, Pineau CA, Clarke AE, Scott S, Fombonne É, Joseph L, et al. Increased Risk of Autism Spectrum Disorders in Children Born to Women With Systemic Lupus Erythematosus: Results From a Large Population-Based Cohort. Arthritis Rheumatol. 2015 Dec. 67 (12):3201-8. .
15. Vinet É, Pineau CA, Scott S, Clarke AE, Platt RW, Bernatsky S. Increased congenital heart defects in children born to women with systemic lupus erythema-tosus: results from the offspring of Systemic Lupus Erythematosus Mothers Registry Study. Circulation. 2015 Jan 13. 131 (2):149-56.
16. McGrory CH, McCloskey LJ, DeHoratius RJ, et al. Pregnancy outcomes in female renal recipients: a comparison of systemic lupus erythematosus with other diagnoses. Am J Transplant. 2003 Jan. 3(1):35-42.
17. Ostanek L, Milchert M (2006) Pregnancy associated with connective tissue disease. Ann Acad Med Stetin 52(Suppl 2):11–16
18. Andreoli L, Fredi M, Nalli C, Reggia R, Lojacono A, Motta M et al (2012)10.Diniz-da-Costa T, Centeno M, Pinto L, Marques A, Mendes-Graça L (2012) Systemic lupus erythematosus and pregnancy. Acta Med Port 25(6):448–453.