INCREASED RATE OF LUPUS FLARE DURING PREGNANCY AND THE PUERPERIUM - APROSPECTIVE-STUDY OF 78 PREGNANCIES

The objective was to determine whether the frequency of flare in syste mic lupus erythematosus (SLE) patients is increased during pregnancy a nd the puerperium. Seventy-eight pregnancies in 68 SLE patients attend ing the lupus pregnancy clinic, at St Thomas' Hospital, during the las t 5 yr were included. The pregnancy period and 8 weeks post-delivery w ere considered. This group was compared with a control group of 50 con secutive, non-pregnant, age-matched SLE patients attending our weekly lupus clinic. Additionally, 43 of the pregnant patients carried on att ending the lupus clinic for the year after puerperium, and their cours e was compared with themselves during pregnancy. SLE activity was asse ssed using the Lupus Activity Index (LAI) score. An increase greater t han or equal to 0.26 in the score was considered as a flare of the dis ease. Pregnancy and control groups were homogeneous for age, race, dis ease duration and distribution of autoantibodies. Sixty-five per cent of the patients flared during pregnancy and/or the puerperium and 42% flared in the control group (P = 0.015). The rates of flare per patien t/month were 0.082 +/- 0.004 for the pregnancy group and 0.039 +/- 0.0 03 for the control group (P <0.001). The 43 patients whose course was controlled after the puerperium flared more frequently during pregnanc y than thereafter (McNemar test, P = 0.003). The rates of flare per pa tient/month were 0.093 +/- 0.006 during pregnancy and the puerperium, and 0.049 +/- 0.004 after the puerperium (P = 0.0015). Kidney and cent ral nervous system involvement was not different between the pregnancy and control groups. In terms of frequency of flares, there was no dif ference in any of the groups between patients taking and not taking st eroids. We conclude that SLE tends to flare during pregnancy. Flares a re maximal during the second and third trimester and the puerperium. F lares are not more severe than in non-pregnant patients, and most of t he flares can be managed conservatively. Prednisolone does not prevent flares.