FETAL-OUTCOME IN LUPUS PREGNANCY - A RETROSPECTIVE CASE-CONTROL STUDYOF 242 PREGNANCIES IN 112 PATIENTS

Fetal outcome in systemic lupus erythematosus (SLE) was retrospectivel y analysed in 242 pregnancies in 112 unselected patients, and the outc ome was compared with that of 417 pregnancies in 192 control women mat ched for age, parity and socio-economic status. Relative risk for feta l loss after the diagnosis of SLE was 2.5 (95% confidence interval (CI ), 1.4-4.5), for prematurity 5.8 (3.2-10.5) and for intra-uterine grow th retardation (IUGR) 8.6 (3.0-24.3). Fetal outcome of pregnancy in pa tients with pre-existing stable lupus nephritis was no worse than in o ther SLE pregnancies. Relations of three lupus anticoagulant (LA) assa ys and three anticardiolipin (aCL) enzyme-linked immunosorbent assays to fetal outcome were studied. Patients positive by any LA assay had a previous fetal loss more often than patients negative by all LA assay s (odds ratio 3.4; 95% CI, 1.3-9.0; P = 0.01). Of the 41 patients whos e antiphospholipid antibody (aPL) tests were all negative, five (12%) had a history of fetal loss (16% in controls). As a group, aCL was mor e sensitive for fetal loss than LA (64% vs 50%), but LA was more speci fic (77% vs 52%). Combinations of one aCL assay with one LA assay had a 41-73% sensitivity and a 64-73% specificity for a history of fetal l oss. aPL did not correlate to prematurity or fetal growth retardation. In conclusion, fetal loss in SLE is 2.5 times more prevalent than in the normal population. The presence of LA indicates a high risk for fe tal loss, and the absence of aPL is an indication of a favorable pregn ancy outcome. Prematurity and IUGR are common in SLE, but they are not associated with aPL.