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Immunological disease activity parameters at conception are risk factors for preterm birth and low birth weight in
Hiromi Shimada1, Risa Wakiya1, Tomohiro Kameda1
1Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Insights
Disease activity in systemic lupus erythematosus (SLE) significantly impacts pregnancy outcomes. Monitoring complement levels and anti-dsDNA antibody titers can help predict and manage preterm birth and low birth weight risks.
Area of Science:
- Rheumatology
- Obstetrics
- Immunology
Background:
- Systemic lupus erythematosus (SLE) poses significant risks during pregnancy.
- Preterm birth (PB) and low birth weight (LBW) are known complications in SLE pregnancies.
- Identifying specific disease activity markers associated with adverse pregnancy outcomes is crucial.
Purpose of the Study:
- To identify disease activity parameters that are risk factors for PB and LBW in SLE patients.
- To analyze the extent of the impact of these parameters on PB and LBW.
Main Methods:
- Retrospective analysis of 60 pregnancies in SLE patients.
- Collection of disease activity parameters: SLE Disease Activity Index (SLEDAI), lupus low disease activity state (LLDAS) attainment, complement levels (C3, CH50), and anti-double stranded DNA (anti-dsDNA) antibody titers.
- Association analysis of these parameters with PB and LBW.
Main Results:
- C3 levels and anti-dsDNA antibody titers at conception were associated with PB (p=0.03, p=0.01).
- C3 and CH50 levels were associated with LBW (p=0.02, p=0.03).
- Logistic regression identified cutoff values for C3, anti-dsDNA, and CH50, with combined cutoffs significantly increasing PB and LBW risk.
Conclusions:
- PB and LBW are strongly linked to specific disease activity parameters in SLE pregnancies.
- Close monitoring and control of SLE disease activity markers, even without overt clinical symptoms, are vital for improving pregnancy outcomes.
- Proactive management of SLE disease activity can mitigate risks of PB and LBW.
Objective:
This study aimed to identify which disease activity parameters may be risk factors for preterm birth (PB) and low birth weight (LBW) in patients with systemic lupus erythematosus (SLE). We also analyzed the extent to which these parameters affected PB and LBW.
Methods:
We collected the SLE Disease Activity Index (SLEDAI), the rate of lupus low disease activity state (LLDAS) attainment, complement levels, and the titer of anti-double stranded DNA (dsDNA) antibody as disease activity parameters. We retrospectively analyzed the associations of these parameters with PB and LBW.
Results:
Sixty pregnancies were included in this study. C3 levels and anti-dsDNA antibody titers at conception were strongly associated with PB (p = 0.03 and p = 0.01, respectively), whereas C3 and CH50 levels were associated with LBW (p = 0.02 and p = 0.03, respectively). A logistic regression analysis showed that the cutoff values of C3 and anti-dsDNA antibody for PB were 62.0 mg/dl and 5.4 IU/ml, respectively. The cutoff values of C3 and CH50 for LBW were 87.0 mg/dl and 41.8 U/ml, respectively. The risk of PB or LBW was increased when divided by the cutoff value, and the combination of these cutoff values showed a significantly higher risk of PB and LBW (p = 0.01 and p < 0.01, respectively).
Conclusions:
PB and LBW are strongly associated with disease activity parameters in patients with SLE. Therefore, strictly monitoring and controlling these disease activity parameters, with or without clinical manifestation, is important for women who want to become mothers.
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