Regular obstetric practice, blood pressure, fetal heartbeat, clinical symptoms of lupus, laboratory tests including complete blood count, routine urine test, blood biochemical test, 24-hour urine protein, complement C3 and C4, anti-dsDNA antibodies, anti-SSA antibodies, anti-SSB antibodies, antiphospholipid antibody (including anticardiolipin (aCL) antibody IgM, aCL antibody IgG, and anti- β2GP1 antibody lupus anticoagulants (LAC)), and medical treatments were recorded. Patients who were not followed regularly or without complete records were excluded. Planned pregnancy was defined according to Chinese recommendations for perinatal management in women with SLE, as lupus patients who were allowed to conceive under the situation of (1) stable disease activity for at least six months (2) dose of oral prednisone < 15 mg per day) (3) urine protein < 0.5 g/24 hours (4) absence of major organ dysfunction (5) discontinuation of immunosuppressants including cyclophosphamide, methotrexate, and mycophenolate mofetil for at least six months and (6) for those who were taking leflunomide, wash-out therapy should be administered and leflunomide was withdrawn for at least six months.Īll pregnant women with SLE in the Chinese tertiary hospitals were followed according to Chinese recommendations for perinatal care in high-risk women, namely, every four weeks up to the 28th week of gestation and every two weeks from the 28th week up to delivery. All patients fulfilled the 1997 ACR diagnostic criteria for SLE. Only one pregnancy for each patient was included. Therefore, we performed a retrospective multicenter research in South China aimed at investigating the fetal and maternal outcomes, predictors of APOs, and pregnancy-associated disease flares in women with SLE who underwent planned pregnancy and close pregnancy monitoring by a multidisciplinary team.Ī total of 243 patients with SLE who underwent planned pregnancy from three tertiary hospitals in Guangzhou from December 2011 to December 2016 were included (127 pregnancies in the First Affiliated Hospital of Sun Yat-sen University 66 pregnancies in Guangzhou First People's Hospital, the Second Affiliated Hospital of South China University of Technology and 50 pregnancies in the Third Affiliated Hospital of Guangzhou Medical University). Currently, patients with SLE were advised to consider pregnancy during periods of inactive or stable disease, the so-called “planned pregnancy.” However, such researches usually enrolled a small number of candidates, and data is lacking in China. Moreover, the occurrence of disease flares increases during SLE pregnancies but decreases if pregnancy is delayed until disease is quiescent. However, recent studies have reported that fetal outcomes are relatively favorable if lupus is stable or mildly active. A number of studies have shown that patients with SLE are more likely to develop fetal complications, including fetal loss, preterm birth, and IUGR, compared to healthy women. Multiple analysis showed that disease flares (OR, 8.1 CI, 3.8–17.2) and anticardiolipin antibody positivity (OR, 7.4 CI, 2.5–21.8) were associated with composite fetal APOs.Ĭompared with the general population, patients with SLE are still at high risk of adverse pregnancy outcomes (APOs). Pregnancy-induced hypertension (PIH) occurred in 29 patients, among which 3 were gestational hypertension and 26 were preeclampsia. Disease flares were mainly presented as active lupus nephritis (41/52, 78.8%), thrombocytopenia (10/52, 19.2%), and skin/mucosa lesions (9/52, 17.3%). Forty-two preterm infants (42/54, 77.8%) were delivered after the 34th week of gestation. Preterm births, intrauterine growth retardation (IUGR), fetal distress, and fetal loss accounted for 22.2%, 14.8%, 11.1%, and 4.9%, respectively. Duration of SLE prior to pregnancy was 4.4 ± 4.3 years. The average age at conception was 28.9 ± 3.9 years.
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