Factors associated with adverse pregnancy outcomes in patients with systemic lupus erythematosus (sle)

BackgroundPregnancies in systemic lupus erythematosus (SLE) are considered high risk and associated with maternal and obstetric complications.ObjectivesOur goal with this study was to determine the most important predictors for each of the main adverse pregnancy outcomes in SLE patients.MethodsWe conducted a retrospective case-controls study by including multiparous women diagnosed with SLE from 1980 to 2020 followed in our unit and compared the clinical profile of patients with adverse pregnancy outcomes to control SLE patients. We excluded elective terminations of pregnancy and cases lost to follow-up. Qualitative data were analyzed by Chi-square test and Fisher’s exact test and continuous variables were analyzed by using Student’s t test. Multiple logistic regression models were performed to determine the predictive factors for adverse pregnancy outcomes with adjustment of confounding factors. In all tests, P values less than 0.05 were considered to be statistically significant.Results135 multiparous women were included (43% with adverse pregnancy outcomes). The mean age of patients at inclusion was 55.8 (46-64) years. Abortion occurred in 33 patients (57%), pre-eclampsia in 10 patients (17%), ectopic pregnancy in 5 patients (8%), preterm labor in 5 patients (8%), placental abnormalities in 4 patients (6%), stillbirth in 4 patients (6%), premature rupture of membranes (PROM) and neonatal lupus in 3 patients (5%), respectively. 121 patients (89%) have pre-existing lupus and 14 (11%) referred with SLE onset in pregnancy. Renal involvement (p=0.03), anti-DNAds positivity (p=0.002), antiphospholipid antibody (APA) positivity (p=0.001), anti-Ro/SSA (p=0.003) and a younger age at disease onset (p=0.01) were significantly associated with unfavorable pregnancy outcomes. Abortion was correlated with anti-DNAds (β=0.71. p=0.04), renal involvement (β=0,28, p 0.03) and APA (β=0.2, p 0.03). Stillbirth was also correlated with renal involvement (β= 0.26, p =0.04) and APA (β=0.22, p=0.03). Preeclampsia was correlated with direct Coombs positivity (β=0.42, p=0.01) and serositis (β=0.31, p=0.02). Neonatal Lupus was correlated with anti-RNP (β=0.16, p=0.03) and anti-Ro/SSA (β=0.16, p 0.02). Renal involvement and APA had a 2.6-fold increased risk of unfavorable pregnancy outcomes (OR 2.6 95% (1.1-6.1), p 0.03) and APA had a 4.3-fold increased risk of unfavorable pregnancy outcomes (OR 4.3 95% IC 2.1-8.8), p 0.002).ConclusionThe most unfavorable pregnancy outcomes in women with SLE was spontaneous abortion. Renal involvement, anti-DNAds and anti-Ro/SSA, antiphospholipid antibody positivity, and a younger age at disease onset increased the risk of pregnancy complications.Table 1.Multiple logistic regression analysisAbortionStillbirthPre-eclampsiaPROMEctopic pregnancyNeonatal LupusAnti-DNAdsβ =0,71, p=0.04β =0.26, p=0.04β =0.12, p=0.38β =0.15, p =0.24β = 0.10, p =0.64β = 0.16, p=0.24APAβ = 0.2, p = 0.03β = 0.22, p=0.03β = 0.11, p = 0.85β = 0.26, p = 0.04β = 0.16, p = 0.21β = 0.83, p = 0.08Renal involvementβ=0,28, p 0.03β = 0.26, p = 0.38β = 0.33, p = 0.83β = 0.07, p = 0.53β = 0.17, p = 0.20β = 0.58, p = 0.07Serositisβ = 0.85, p = 0.95β = 0.11, p = 0.41β=0.31, p=0.02β = 0.06, p = 0.46β = 0.13, p = 0.35β = 0.08, p = 0.46Direct Coombs positivityβ =0.11, p = 0.41β = 0.03, p = 0.81β = 0.42, p=0.01β=0.03, p =0.83β= 0.14, p = 0.81β=0.03, p=0.83Anti-Ro/SSAβ=0.19, p = 0.13β=0.03, p = 0.83β=0.07, p =0.62β=0.11, p=0.39β=0.09, p=0.52β= 0.16, p 0.02Anti-RNPβ =0.5, p=0.69β = 0.09, p=0.49β = 0.16, p= 0.23β = 0.09, p= 0.81β=0.03, p=0.81β=0.16, p=0.03References[1]Palma dos Reis, C.R., Cardoso, G., Carvalho, C. et al. Prediction of Adverse Pregnancy Outcomes in Women with Systemic Lupus Erythematosus. Clinic Rev Allerg Immunol 59, 287–294 (2020). https://doi.org/10.1007/s12016-019-08762-9[2]Zamani, B., Shayestehpour, M., Esfahanian, F. et al. The study of factors associated with pregnancy outcomes in patients with systemic lupus erythematosus. BMC Res Notes 13, 185 (2020). https://doi.org/10.1186/s13104-020-05039-9Disclosure of InterestsNone declared