FRI0217 PREGNANCY OUTCOME IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS IN TERTIARY UNIVERSITY HOSPITAL IN EGYPT

Background:

Pregnant systemic lupus erythematosus (SLE) patients have various risks to their fetus and themselves because a severe disease flare may be life-threatening, and some of the medications that are used to treat SLE adversely affect fetus.⁽¹⁾

Objectives:

To evaluate the pregnancy outcome in SLE patients and to determine the predictive factors for adverse fetal and maternal outcomes.

Methods:

The study was conducted on the pregnant SLE patients attending Rheumatology department, Zagazig University hospitals in the period from January 2013 to January 2018. The data was collected retrospectively; demographic, laboratory and serological data on all patients, age at the onset of SLE, disease duration, systems affected, their disease activity using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), treatment received immunosuppressive regimen (dose and duration) before and during pregnancy, SLE flare during pregnancy, the fetal and the maternal outcomes.

Results:

Fifty- two pregnancies were observed in 49 SLE patients with mean age of (27.5±5.6), mean SLE disease duration (3.7±2.2) and mean SLEDAI (5.4±6.1). 39 (75%) pregnancies with successful live births and 13(25%) fetal losses were observed. 36 of the live births (92.3%) were full-term and 3 (7.7%) were preterm births. Fetal losses included six spontaneous abortions, 3 stillbirths and 4 therapeutic abortions; 2 of them due to observed fetal anomalies and one due to life threatening lupus flare. We found SLEDAI significantly higher in patients with lost pregnancies (p<0.0001) than successful pregnancies. Proteinuria during pregnancy was a predictive factor for adverse fetal outcomes (odds ratio [OR] 19.7; P < 0.0001), also the presence of antiphospholipid antibodies (OR 15.3; P<0.0001), low C3 and C4 (OR 15.3; P<0.0001), anti-RO antibodies (OR 11.1; P=0.02), anti-LA (OR 4.7; P=0.03), chronic hypertension (OR 54.8; p<0.0001) and SLE flares(OR 32; p=0.003). SLE flares occurred in 10 pregnancies (19.2%), mostly during the second trimester (60%). Renal involvement (70%) was the most common SLE flare during pregnancy. SLE flares during pregnancy were highly associated by nephritis prior to pregnancy (adjusted OR 9; P = 0.04) and the presence of antiphospholipid antibodies (adjusted OR 12; p=0.01).

Conclusion:

Favorable pregnancy outcome was observed in Egyptian SLE patients; particularly in those with longer period of remission. Planned pregnancy is very important to reduce undesirable fetal and maternal outcomes in SLE patients. The presence of lupus nephritis, chronic hypertension, antiphospholipid syndrome, active disease at the onset of pregnancy, and proteinuria were highly associated with bad outcome.

References:

[1] Phansenee, S., Sekararithi, R., Jatavan, P., & Tongsong, T. (2018). Pregnancy outcomes among women with systemic lupus erythematosus: a retrospective cohort study from Thailand. Lupus, 27(1), 158–164.

Disclosure of Interests:

None declared