Outcome of lupus pregnancy: a controlled study

Objective. The reciprocal relationship between systemic lupus erythematosus (SLE) and pregnancy was investigated in a controlled study. Method. The outcome of 47 pregnant SLE patients with 59 pregnancies was com pared with that of 57 healthy control women and 59 pregnancies. The results were also compared with those of 59 non-pregnant control SLE patients. Results. All pregnant SLE patients but one were in remission at the onset o f pregnancy and were being treated with low doses of prednisone (less than or equal to 10 mg/day, 26 patients), hydroxychloroquine (200 mg/day, eight patients) or azathioprine (100 mg/day, one patient). Sixty-one per cent of SLE pregnancies were delivered at term and 5% had premature deliveries. The rates of spontaneous abortion and total fetal loss were significantly high er in the mothers with SLE than in the control population (P < 0.001 and P < 0.01 respectively). None of the 39 neonates from SLE mothers had neonatal lupus, anti-Ro(SSA) or anti-La(SSB) antibodies. Eight out of 59 pregnancie s of SLE mothers (13.5%) were characterized by disease exacerbation. Arthra lgias or arthritis, fever and skin lesions were observed more frequently in the mothers with SLE than in the non-pregnant group (P < 0.001). Renal inv olvement was found in three SLE patients during pregnancy and in three afte r delivery. Conclusions. Pregnant women with SLE are at high risk of fetal loss and spo ntaneous abortion. Pregnancy does not cause life-threatening manifestations of the disease. Thus, for a better outcome of lupus pregnancy, it is essen tial to control disease activity and to achieve clinical remission.