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Maternal and Fetal Outcomes in Iranian Patients with Systemic Lupus Erythematosus: A Five Year Retrospective Study of 60 Pregnancies.

Abstract

BACKGROUND

As a multisystem autoimmune disease, systemic lupus erythematosus (SLE) mainly affects women during reproductive age. This retrospective study was designed to investigate the fetal and maternal outcomes of Iranian women with SLE.

METHODS

Clinical and laboratory records of 60 pregnancies in 55 SLE patients who attended Hafez hospital, a tertiary referral center for high risk pregnancies and SLE patients affiliated with Shiraz University of Medical Science, were reviewed during April 2012 and March 2016.

RESULTS

The mean age of the patients was 29.28±4.6 years and mean disease duration was 5.09±4.2 years. Live birth rate was 83.3% after exclusion of elective abortions. There were 50 live births, 3 neonatal deaths, 3 spontaneous abortions and 7 stillbirths. 9 (15%) women developed preeclampsia and there was 1 (1.6%) case of HELLP syndrome. Lupus flares occurred in 27 (45%) patients during pregnancy. Preterm delivery occurred in 11.6% of pregnancies. Skin and joints were the most frequently affected organs. Patients with previous lupus nephritis (n=18) were associated with a higher risk of maternal complication, but fetal outcomes were similar in both groups. Cesarean rate was about 66%, mostly related to fetal indications (50%).

CONCLUSION

Pregnancies in most women with pre-existing SLE can now be managed with successful results although presence of previous lupus nephritis is still a major risk factor for adverse maternal outcomes. In our study, fetal outcome was not different between patients with lupus nephritis compared with the patients without nephritis who were under treatments. Hence, to achieve favorable long-term results, we recommend regular multispecialty treatment approaches and progestational counseling for women with SLE.

Authors+Show Affiliations

Department of Internal Medicine, Division of Rheumatology, Shiraz University of Medical Sciences. Iran.Department of Internal Medicine, Division of Rheumatology, Shiraz University of Medical Sciences. Iran.Maternal-fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30686262

Citation

Karimzadeh, P, et al. "Maternal and Fetal Outcomes in Iranian Patients With Systemic Lupus Erythematosus: a Five Year Retrospective Study of 60 Pregnancies." Current Rheumatology Reviews, 2019.
Karimzadeh P, Shenavandeh S, Asadi N. Maternal and Fetal Outcomes in Iranian Patients with Systemic Lupus Erythematosus: A Five Year Retrospective Study of 60 Pregnancies. Curr Rheumatol Rev. 2019.
Karimzadeh, P., Shenavandeh, S., & Asadi, N. (2019). Maternal and Fetal Outcomes in Iranian Patients with Systemic Lupus Erythematosus: A Five Year Retrospective Study of 60 Pregnancies. Current Rheumatology Reviews, doi:10.2174/1573397115666190125162248.
Karimzadeh P, Shenavandeh S, Asadi N. Maternal and Fetal Outcomes in Iranian Patients With Systemic Lupus Erythematosus: a Five Year Retrospective Study of 60 Pregnancies. Curr Rheumatol Rev. 2019 01 25; PubMed PMID: 30686262.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal and Fetal Outcomes in Iranian Patients with Systemic Lupus Erythematosus: A Five Year Retrospective Study of 60 Pregnancies. AU - Karimzadeh,P, AU - Shenavandeh,S, AU - Asadi,N, Y1 - 2019/01/25/ PY - 2018/11/16/received PY - 2019/01/16/revised PY - 2019/01/17/accepted PY - 2019/1/29/entrez PY - 2019/1/29/pubmed PY - 2019/1/29/medline KW - Iran KW - Lupus flare KW - Outcome KW - Pregnancy KW - Systemic lupus erythematosus JF - Current rheumatology reviews JO - Curr Rheumatol Rev N2 - BACKGROUND: As a multisystem autoimmune disease, systemic lupus erythematosus (SLE) mainly affects women during reproductive age. This retrospective study was designed to investigate the fetal and maternal outcomes of Iranian women with SLE. METHODS: Clinical and laboratory records of 60 pregnancies in 55 SLE patients who attended Hafez hospital, a tertiary referral center for high risk pregnancies and SLE patients affiliated with Shiraz University of Medical Science, were reviewed during April 2012 and March 2016. RESULTS: The mean age of the patients was 29.28±4.6 years and mean disease duration was 5.09±4.2 years. Live birth rate was 83.3% after exclusion of elective abortions. There were 50 live births, 3 neonatal deaths, 3 spontaneous abortions and 7 stillbirths. 9 (15%) women developed preeclampsia and there was 1 (1.6%) case of HELLP syndrome. Lupus flares occurred in 27 (45%) patients during pregnancy. Preterm delivery occurred in 11.6% of pregnancies. Skin and joints were the most frequently affected organs. Patients with previous lupus nephritis (n=18) were associated with a higher risk of maternal complication, but fetal outcomes were similar in both groups. Cesarean rate was about 66%, mostly related to fetal indications (50%). CONCLUSION: Pregnancies in most women with pre-existing SLE can now be managed with successful results although presence of previous lupus nephritis is still a major risk factor for adverse maternal outcomes. In our study, fetal outcome was not different between patients with lupus nephritis compared with the patients without nephritis who were under treatments. Hence, to achieve favorable long-term results, we recommend regular multispecialty treatment approaches and progestational counseling for women with SLE. SN - 1875-6360 UR - https://www.unboundmedicine.com/medline/citation/30686262/Maternal_and_Fetal_Outcomes_in_Iranian_Patients_with_Systemic_Lupus_Erythematosus:_A_Five_Year_Retrospective_Study_of_60_Pregnancies L2 - http://www.eurekaselect.com/169377/article DB - PRIME DP - Unbound Medicine ER -