Lupus nephritis and pregnancy

Sixty-four pregnancies in 41 women with biopsy proven lupus nephritis between 1965 and 1991 were analysed to record fetal and maternal outcome and identify risk factors for poor outcome. Of 65 fetuses, 22 (34 per cent) were lost (including therapeutic abortions), 19 (30 per cent) were live born but premature (less than or equal to 36 weeks gestation) and 24 (37 per cent) were term. Fetal loss after 20 weeks gestation was 19 per cent. Twelve per cent of 25 fetuses whose birthweight was recorded were small for gestational age. Maternal renal function deteriorated in 19 per cent of pregnancies but was irreversible post-partum in only one woman (2 per cent). Hypertension was recorded in 44 per cent of pregnancies, developed early (less than or equal to 32 weeks gestation) in 28 per cent and was severe in 13 per cent. Treated hypertension predated 17 per cent of pregnancies and in 6 per cent (included in the overall incidence of hypertension) exacerbation occurred during pregnancy despite continued anti-hypertensive medication. Nine women (22 per cent) who developed de novo hypertension in pregnancy had permanent hypertension post-partum. Increased proteinuria was recorded in 48 per cent of pregnancies and was irreversible post partum in 5 per cent. Comparison of pregnancies occurring before or after diagnosis was made by renal biopsy failed to show any significant difference in fetal outcome. Pregnancies occurring after the diagnosis of glomerulonephritis were associated with a significantly lower incidence of maternal hypertension, early hypertension, severe hypertension and increased proteinuria. The presence of the circulating lupus anticoagulant was clearly associated with a significantly high fetal loss rate although the incidence of maternal complications did not differ significantly between mothers positive or negative for lupus anticoagulant.