A study has identified several predictors of poor pregnancy outcomes in women with lupus, including disease flares less than six months before conception and use of immunosuppressants.
The research, “Predictors of poor obstetric outcome in women with systemic lupus erythematosus: a 10-year experience of a university hospital,” was published in The Journal of Maternal-Fetal & Neonatal Medicine.
Previous studies had suggested that pregnant women with lupus were at increased risk of flares, hypertension and premature births. These observations highlighted the need for doctors to monitor the women and their fetuses closely as a way of improving their chances of having better outcomes.
Researchers decided to build on the research by seeing if they could identify predictors of poor outcomes in pregnant women with lupus and their babies. Their analysis was based on records at Menoufia University Hospital in Egypt between 2005 and 2010.
Doctors diagnosed the patients’ lupus before they became pregnant, but most of the patients had not received preconception assessments. These evaluations including preconception counseling, medication reviews, and laboratory work on kidney function and the possible presence of harmful antibodies.
To compare the care that women with and without preconception assessments received, the research team followed up with those who had received preconception assessments.
Altogether, the analysis included 236 women who had received no preconception assessment and 214 who did.
Patients who had received no preconception assessment were at increased risk of developing a blood clot, of having their baby die in the womb, of giving birth prematurely, and of needing to have a medically related abortion. The group was also at higher risk of having more lupus flares, worsened kidney function, more blood transfusions, and dying than women who had received a preconception assessment.
The findings suggested that close monitoring of pregnant women with lupus can improve both maternal and fetal outcomes, the team said.
Researchers identified several predictors of a poor outcome for the mother or child. One was a mother having a lupus flare less than six months before becoming pregnant. Another was her having to be admitted to a hospital at least six times before giving birth. Still another was a mother using an immunosuppressant. A fourth predictor was a woman having anti-SSA/Ro or anti-SSB/La antibodies her system. And the fifth was a mother having lupus-related kidney inflammation, or lupus nephritis.
Researchers said lessons from their study included “the importance of postponing pregnancy when predictors of poor outcome are encountered, judicious use of immunosuppressive and antihypertensive therapy, and the need for expert close monitoring throughout pregnancy to achieve better outcome.”