[Epidemiologic study of pregnancy complicated by lupus]

Pregnancy is allowed in an increasing number of women with systemic lupus erythematosus (SLE). In order to determine the influence of pregnancy on SLE and vice versa, a French epidemiological register was established on 1 January 1987, under the aegis of the Société Nationale Française de Médecine Interne. As of 1 December 1989, 55 pregnancies in 51 women coming from 24 different Departments of Medicine were recorded. Intermediate results were analyzed from 42 women (2 successive pregnancies) of which 46 pregnancies (2 twin pregnancies) have come to term. Pregnancy can be allowed in women with SLE. The disease influences its evolution in nearly two-thirds of the patients, but without maternal death. Among 4 women whose disease previously undiagnosed, 2 developed glomerulonephritis. A woman without prior renal involvement developed proliferative diffuse glomerulonephritis during pregnancy. Fetal prognosis appears to be linked to the activity of the disease at the beginning of pregnancy: early spontaneous abortions always occurred when the disease was active, even if the signs of activity were only biological. This fact underlies the importance of complement dosage because the physiological expression of the usual inflammatory parameters increases during pregnancy. In addition, it seems that SLE treatment should be adapted to the evolution of biological tests. Renal involvement regardless of its origin--SLE or not--(it is often impossible to determine the respective contribution of each cause, which leads to increasing the corticosteroid dosage and giving antihypertensive drugs simultaneously) seems to be a factor of prematurity.