SLE during pregnancy, maternal and perinatal outcome in teritary hospital

. Leelavathi, Nayana D. H., Triveni Kondareddy, Kaytri S.


Background: SLE is an autoimmune disease most frequently found in women of child bearing age and may co­exist with pregnancy. Its multisystem involvement and therapeutic interventions pose a high risk for both the mother and the foetus. Disease flares in pregnancy pose challenges with respect to distinguishing physiologic changes related to pregnancy from disease related manifestations. The present study analyzes the fetomaternal outcome of pregnant women with SLE.

Methods: An analysis of fetomaternal outcome of pregnant women with SLE during April  2015 to May 2016 at JSS hospital.

Results: During the period from April 2016 to May 2016, 3773 deliveries were conducted in the department. Eleven pregnant women with SLE were followed up during this period, giving an incidence of 0.29/1000 deliveries. A high rate of lupus flare during pregnancy was found in the current study. Even among women in remission for more than six months before pregnancy, the rate of lupus flare was not low (27%). Also other complications seen were pre-eclampsia 54.54%, HELLP syndrome in 9.09% , PPH in 50%, polyserositis seen in 9.09% and one maternal death was seen (9.09%). No neonate suffered from heart-blocker however there was 75 % NICU admissions among live borns.

Conclusions: Advancing technology and better understanding of the maternal-foetal relationship in lupus have improved outcomes in lupus pregnancies over the last decade. The multisystem nature of the disease, the severity of the organ involvement needs to be assessed and a multidisciplinary approach is required for its diagnosis and successful management.


Maternal outcome, Perinatal outcome, Pregnancy, SLE

Full Text:



Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol. 2010;5:2060-8.

Stojan G, Alan NB. Flares of systemic lupus erythematosus during pregnancy and the puerperium: Prevention, diagnosis and management. Expert Rev Clin Immunol. 2012;8:439-53.

Mintz G, Niz J, Gutierrez G, Alonso A, Karchmer S. Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach. J Rheumatol. 1986;13:732-9.

Georgiou PE, Politi EN, Katsimbri P, Katsimbri P, Sakka V, Drosos AA. Outcome of lupus pregnancy: A controlled study. Rheumatology. 2000;39:1014-9.

Soubassi L, Haidopoulos D, Sindos M, Pilalis A, Chaniotis D, Diakomanolis E, et al. Pregnancy outcome in women with pre-existing lupus nephritis. J Obstet Gynaecol. 2004;24:630-4.

Lateef A, Petri M. Management of pregnancy in systemic lupus erythematosus. Nat Rev Rheumatol. 2012;8:710-8.

Yang MJ, Cheng MH, Lin HY. Onset of systemic lupus erythematosus during pregnancy. J Chin Med Assoc. 2006;69:130-3.

Clowse ME, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 2008;199:127-30.

Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ. 1997;314:253-7.

Ticconi C, Rotondi F, Veglia M, Pietropolli A, Bernardini S, Ria F, et al. Antinuclear autoantibodies in women with recurrent pregnancy loss. Am J Reprod Immunol. 2010;64:384-92.

Petri M, Howard D, Repke J. Frequency of lupus flare in pregnancy. The Hopkins Lupus Pregnancy Center experience. Arthritis Rheum. 1991;34:1538-45.

Hernández CJ, Ros OJ, Paredes F, Casellas M, Castillo F. Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: A prospective study of 103 pregnancies. Rheumatology (Oxford). 2002;41:643-50.

Brucato A, Cimaz R, Caporali R, Ramoni V, Buyon J. Pregnancy outcomes in patients with autoimmune diseases and anti-Ro/SSA antibodies. Clin Rev Allergy Immunol. 2011;40:27-41.

Ko HS, Ahn HY, Jang DG. Pregnancy outcomes and appropriate timing of pregnancy in 183 pregnancies in Korean patients with SLE. Int J Med Sci. 2011;8:577-83.

Izmirly PM, Saxena A, Kim MY, Wang D, Sahl SK, Llanos C, et al. Maternal and fetal factors associated with mortality and morbidity in a multi-racial/ethnic registry of anti-SSA/Ro-associated cardiac neonatal lupus. Circulation. 2011;124:1927-35.

Aggarwal N, Raveendran A, Suri V, Chopra S, Sikka P, Sharma A. Pregnancy outcome in systemic lupus erythematosus: Asia’s largest single centre study. Arch Gynecol Obstet. 2011;284:281-5.

Tian X, Li M, Ye Z, Zhang X, Liu S. Related factors of fetal loss in Chinese women with systemic lupus erythematosus: data from chinese SLE treatment and research group registry IV. Int J Rheum Dis. 2014;5:22-7.

Buyon JP, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, et al. Predictors of pregnancy outcomes in patients with lupus: a cohort study. Ann Intern Med. 2015;163:153-63.

Lockshin MD. Pregnancy does not cause systemic lupus erythematosus to worsen. Arthritis Rheum. 1989;32:665-70.

Lockshin MD, Reinitz E, Druzin ML, Murrman M, Estes D. Case-control prospective study demonstrating absence of lupus exacerbation during or after pregnancy. Am J Med. 1984;77:893-8.

Wong KL, Chan FY, Lee CP. Outcome of pregnancy in patients with systemic lupus erythematosus. A prospective study. Arch Intern Med. 1991;151:269-73.

Irastorza G, Lima F, Alves J, Khamashta MA, Simpson J, Hughes GR, Buchanan NM. Increased rate of lupus flare during pregnancy and the puerperium: A prospective study of 78 pregnancies. Br J Rheumatol. 1996;35:133-8.

Al Arfaj, Khalil N. Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus. 2010;19:1665-73.

Cavallasca JA, Laborde HA, Ruda VH, Nasswetter GG. Maternal and fetal outcomes of 72 pregnancies in Argentine patients with systemic lupus erythematosus (SLE). Clin Rheumatol. 2008;27:41-6.

Zhao CM, Zhao J, Huang Y, Wang Z, Wang H, Zhang H, Xu H, Yang N. New-onset systemic lupus erythematosus during pregnancy. Clin Rheumatol. 2013;32:815-22.