Cognitive Dysfunction in Systemic Lupus Erythematosus During Pregnancy

Systemic lupus erythematosus (SLE) is characterized by an abnormal immune response, leading to elevated levels of autoantibodies that may distress the hepatic, renal, and central nervous systems. Cognitive dysfunction (CD) is the second most common neuropsychiatric symptom reported in SLE patients, after headache. CD has been linked to increased liver serum markers and kidney dysfunction in SLE patients. However, CD has not been previously described in pregnant women with SLE, although it can significantly impact decision-making and quality of life during pregnancy. Our primary goal was to assess the prevalence of CD in pregnant women with quiescent SLE (QSLE). Additionally, we aimed to describe the correlation between CD and serum levels of autoantibodies, complement system components, and hepatic and renal serology.

We conducted a cross-section study involving QSLE pregnant women (n = 63) and healthy pregnant controls (n = 52) in their third trimester. CD was assessed using the MoCA test. Biochemical determinations were performed by ELISA, and clinical data for creatinine and urea were also analyzed.

Higher CD rates were observed in QSLE pregnant women (30.16 %, QSLE CD(+)) compared to the healthy group (5.7%, CTR CD(+)). Serum levels of liver (ALT: QSLE CD(+) 65.9 ± 26.5 vs. QSLE CD(-) 39.9 ± 14.6, p = 0.00) and renal markers (urea: QSLE CD(+) 6.27 ± 2.1 vs. QSLE CD(-) 3.3 ± 1.1, p = 0.00) were significantly elevated in QSLE CD(+) pregnant women. AST and ALT showed a significant correlation with the MoCA score for QSLE CD(+) patients.

MoCA total score, as well as attention, visuospatial/executive, and abstraction domains were found to be impaired in QSLE CD(+) pregnant patients. Subclinical liver and kidney dysfunction were associated with cognitive impairment in QSLE pregnant women.