Risk factors of disease progression and adverse pregnancy outcome in patients with systemic lupus erythematosus during pregnancy

Objective To investigate the risk factors of disease progression and adverse pregnancy outcome in patients with systemic lupus erythematosus (SLE) during pregnancy. Methods Clinical data of 118 pregnant women with SLE admitted from June 2004 to October 2015 were retrospectively analyzed. The patients were divided into selective pregnant group (group A, n=72 cases) and non-selective pregnant group (group B, n=46) according to the disease activity of SLE. The disease progression and pregnancy outcomes were compared between two groups. Results The various system damages occurred in group B, including hematological damage in 16 cases, kidney damage in 19 cases, erythra in 10 cases, arthritis in 10 and serositis in 12 cases; while the corresponding cases in group A were 10, 14, 6, 4 and 4( χ2=7.133, P= 0.008; χ2=6.658, P=0.010; χ2=4.304, P=0.038; χ2=7.030, P=0.008; χ2=10.095, P=0.001). SLE exacerbation occurred in 28 cases (74%) of group B and 12 cases (17%) of group A (χ2=34.944, P= 0.000). The logistic regression analysis showed that hypocomplementemia, proteinuria, SLEDAI score before pregnancy and positive anti-dsDNA antibody were the risk factors of SLE disease exacerbation during pregnancy. The maternal complications occurred in group B, including pregnancy-induced hypertension in 7 cases, preeclampsia in 10 cases and infections in 11 cases/times; while the corresponding cases (case/time) in group A were 2, 6 and 4 (χ2=4.526, P= 0.033; χ2=4.304, P=0.038; χ2=8.525, P=0.004). There were 14 cases of therapeutic induced labor, 7 case of stillbirth and 27 cases of total fetal loss in group B, while the corresponding cases in group A were 2, 0 and 4 (χ2=18.317, P= 0.000; χ2=9.080, P= 0.003; χ2=40.920, P= 0.000). The logistic regression analysis showed that positive anticardiolipin antibody, proteinuria, SLEDAI score before pregnancy and renal dysfunction during pregnancy were risk factors of fetal loss. There were 87 cases of successful delivery (73.7%), the successful delivery rates were 41.3% (19/46) in group B and 94.4% (68/72) from group A, respectively. The infant complications occurred in group B, including premature birth in 15 cases, low birth weight in 13 cases, neonatal jaundice in 5 cases and mild asphyxia in 5 cases; while the corresponding cases in group A were 24, 18, 4 and 2 (χ2=11.442, P=0.001; χ2=11.395, P=0.001; χ2=4.664, P= 0.031; χ2=8.035, P=0.005). Conclusion SLE patients whose disease conditions are not well controlled would lead to higher percentage of disease deterioration during pregnancy and worse pregnancy outcomes. Key words: Lupus erythematosus, systemic; Disease progression; Pregnancy outcome