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Pregnancy in systemic lupus erythematosus: a prospective study
R H Derksen1, H W Bruinse, P G de Groot
1Department of Internal Medicine (Section of Clinical Immunology and Infectious Diseases), University Hospital Utrecht, The Netherlands.
Lupus
|June 1, 1994
Summary
Systemic lupus erythematosus (SLE) in pregnancy can be managed successfully. Most pregnant SLE patients in remission experience no disease flares, achieving a 71% live birth rate with optimal care.
Area of Science:
- Obstetrics and Gynecology
- Rheumatology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) poses risks during pregnancy.
- Maternal and fetal outcomes in SLE pregnancies require careful management.
- Protocols for managing SLE during pregnancy aim to improve outcomes.
Purpose of the Study:
- To analyze maternal disease course and fetal outcomes in pregnant patients with SLE.
- To evaluate a protocol designed to optimize maternal and fetal outcomes in SLE pregnancies.
- To assess the impact of disease remission and specific conditions (aPL, lupus nephritis) on pregnancy.
Main Methods:
- Prospective study of 35 pregnancies in 25 SLE patients from 1987-1993.
- Patients were known with SLE at least 6 months prior to pregnancy.
- Follow-up included monitoring disease activity, antiphospholipid antibodies (aPL), lupus nephritis, and creatinine levels.
Main Results:
- 97% of pregnancies started in sustained disease remission.
- 82% of pregnancies maintained inactive maternal disease during gestation.
- 71% of pregnancies resulted in live births; 23% in first-trimester abortions.
Conclusions:
- Most SLE patients conceiving in remission do not experience disease flares during pregnancy.
- Optimal obstetric care, close follow-up, and low-dose aspirin for aPL-positive women lead to high success rates.
- A 71% live birth rate is achievable with appropriate management protocols for pregnant SLE patients.