Are pregnancies with lupus but without APS of good prognosis?

Pregnancies in women with systemic lupus erythematosus (SLE) are at risk of unfavorable perinatal outcomes, especially when antiphospholipid antibody syndrome (APS) is present. Their prognosis is less clear in other situations.

To assess pregnancy prognosis in women with SLE but not APS compared with a control series and determine the poor prognostic factors, if any, detectable before 15 weeks' gestation.

This retrospective case-control study included 137 women with SLE, including 114 without APS, and 274 control women. Unfavorable perinatal outcome was defined by perinatal death (≥ 22 weeks of gestation) or preterm delivery ≤35 weeks.

Pregnancies of the 114 women with SLE but not APS were at more than twice the risk of unfavorable perinatal outcomes compared with those in the control group (18/114 (15.8%) vs 21/274 (7.7%), OR 2.3, 95% 1.1-4.7). After logistic regression, three factors detectable before 15 weeks were associated with an unfavorable perinatal outcome: i. proteinuria and/or hypertension (in 19.3% of the pregnancies) ii. lack of cutaneous lupus (26.3%), and iii. a history of thrombocytopenia-leukopenia-anemia (19.3%). When these factors were absent, the risk of a poor perinatal outcome was very low (3.3%) but increased strongly for pregnancies with one (22.2%) or at least two (44.4%) of these factors.

Among women with SLE but not APS in the first trimester, only the presence of risk factors increases the likelihood of an unfavorable perinatal outcome.

Pregnancies with SLE but not APS are at risk of unfavorable perinatal outcomes only if risk factors are present.