Reproductive Health in Systemic Lupus Erythematosus, An experience from Government Hospital in Western India

Systemic lupus erythematosus is an autoimmune disease which affects the reproductive health of women pertaining to disease or its treatment. However, Indian data is limited. Objective is to study menstrual disturbances and maternal and fetal outcome during pregnancy in SLE patients.

This retrospective and prospective observational study was conducted for a period of 18 months from March 2012 to September 2013 in a tertiary care hospital in Mumbai. The study included serial recruitment of SLE patients fulfilling inclusion criteria.

Out of 52 patients studied, 13(25%) developed amenorrhea; 10 of them reversed and 3 patients developed premature menopause (5.77%). The higher mean age (30 years or more) at initiation of Cyclophosphamide therapy was associated with higher incidence of irreversible amenorrhea and this difference was statistically significant (p=0.0001). Out of 16 SLE pregnancies in 16 different patients, 9 pregnancies were successful while 7 were unsuccessful including IUFDs, abortions and maternal mortality. The incidence of successful pregnancies was significantly higher in low disease activity group (6/N=6, 100%) when compared to high disease activity group (3/N=10, 30%) (p=0.0114).

High disease activity and Cyclophosphamide therapy are the two most important factors causing amenorrhea in SLE patients. Cyclophosphamide therapy when initiated in patients older than 30 years can lead to irreversible amenorrhea. Successful pregnancy is possible even in lupus nephritis patients if disease is well controlled at the time of conception.