Outcome of pregnancies in SLE: a single center experience

We determined the outcome of all pregnancies in SLE patients in our lupus c ohort between 1991 and 1997. The women were advised that pregnancy was acceptable if the disease had bee n inactive for 6 months (SLEDAI less than or equal to (4 at 2 serial examin ations) and daily prednisone dose was below 10mg. Patients were advised aga inst pregnancy in case of active nephritis or neurolupus. In case of antiph ospholipid antibodies, patients were treated with aspirin or heparin if pre vious fetal losses were documented. In case of anti-SSA ab, patients mere m onitored with ultrasound and given dexamethasone in case of atrioventricula r block. Fifty-nine pregnancies were registered among 31 women: mean age at diagnosi s of SLE was 25.3 +/- 3.7 years (range: 17-31); mean disease duration befor e pregnancy 4.4 +/- 3 years (0-14); mean ACR score 5.4 +/- 1.5 (4-9). Seven patients had ACL ab, 8 had anti-SSA ab. Pregnancies ended in: 13 early spo ntaneous abortions (9 not related to disease flare up, 4 related to SAPL); 7 elective abortions (patient decision in 5 cases, severe lupus flare up in 2); one in utero death; 19 full term births (> 38 weeks); and 19 preterm b irths. Cesarean section was performed in 11 cases (6 for fetal distress, dy stocia and previous cesarian; 5 for active lupus). Severe sepsis occurred i n one premature infant who died at the age of 1 week. Intrauterine growth r etardation was observed in 11 cases, mean APGAR score was 8.9 +/- 1.43. Chi ld development was normal in all cases except one child with mild mental re tardation. Severe lupus flare ups occurred in 6 cases, of which 4 were preg nancies in unadvised situations. Six mild flare ups were documented in the post partum. One fatal case of neonatal lupus with AVE was observed. In conclusion, in our experience, the lice birth rate is similar to the gen eral population and the risk of lupus flare up is low when the above mentio ned criteria are applied. Systematic increase of steroid dose at pregnancy onset does not seem to be necessary. The high rate of prematurity remains a problem to be solved.