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Clinical predictors of fetal outcome in systemic lupus erythematosus
P Rahman1, D D Gladman, M B Urowitz
1The University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, Ontario, Canada.
Objective:
To describe the fetal outcomes in systemic lupus erythematosus (SLE) in the University of Toronto Lupus Clinic Cohort and to identify clinical or serological factors that would predict pregnancy loss and poor fetal outcome.
Methods:
Seventy-three patients with 141 pregnancies were identified between 1970 and 1995. Patients were evaluated before pregnancy and at each trimester with a standardized protocol. Analysis included descriptive statistics and univariate and multivariate analysis.
Results:
There were 86 (60.1%) live births, 34 (23.8%) spontaneous abortions, 3 (2.2%) stillbirths, and 20 (14%) therapeutic abortions. Of live births, 21 (24.4%) were premature babies, 6 (7.9%) intrauterine growth retardation, 3 (3.5%) had neonatal lupus, 2 (2.3%) congenital malformations, and there were 2 (2.3%) perinatal deaths. Maternal renal disease was the only statistically significant predictor for fetal loss (p<0.0 12) and hypertension for poor fetal outcome (p<0.024) using univariate analysis.
Conclusion:
Most lupus pregnancies do well, but there is an increased incidence of adverse fetal outcome. Predictive factors for adverse fetal outcome include maternal renal disease and hypertension.