LUPUS NEPHRITIS AND PREGNANCY

Objective: To record fetal and maternal outcome in pregnancies with sy stemic lupus nephritis. Subjects: Twelve pregnancies in 11 women with lupus nephritis were studied. All patients were followed during the en tire term of the pregnancy and for 6 months postpartum. The laboratory studies performed included antinuclear antibody titer (ANA), anti-DNA antibody titer, complement component levels (C3 and C4), lupus antico agulant, anticardiolipin antibody, serum creatinine, 24-h urine protei n, partial thromboplastin time, VDRL, and tests of hematopoietic and h epatic function. Main Outcome Measures: Antenatal and postnatal compli cations of lupus nephritis, proteinuria, hypertension, preterm deliver y, birthweight, and perinatal mortality. Results: Twenty-five percent of pregnancies resulted in fetal loss, 58% in premature delivery, and 17% in term delivery. There were no neonatal deaths. All patients conc eived during a period of clinical remission. Flares of systemic lupus erythematosus (SLE) occurred in four patients. Maternal renal function deteriorated in 25% of the pregnancies but this was reversible in all cases. Increased proteinuria was recorded in 58% of the pregnancies a nd was irreversible in two women (17%). Hypertension occurred in 42% o f the pregnancies, but permanent hypertension postpartum was recorded in only one patient (8%). Conclusions: SLE nephritis remains a high-ri sk condition for pregnancy. Preeclampsia, prematurity, and fetal growt h retardation frequently complicate these pregnancies, and infant morb idity is high. Patients should avoid pregnancy until all manifestation s of nephritis are quiescent.