OUTCOME OF PLANNED PREGNANCIES IN SYSTEMIC LUPUS-ERYTHEMATOSUS - A PROSPECTIVE-STUDY ON 62 PREGNANCIES

We conducted a prospective study in order to determine planned pregnan cy outcome in systemic lupus erythematosus followed in a tertiary refe rral centre. Pregnancy was authorized if disease was inactive on 20 mg /day prednisone or less for at least 1 yr. Upon the diagnosis of pregn ancy, systematic corticosteroids consisting of 10 mg/day prednisone or more were started. In the case of antiphospholipid antibodies, 100 mg /day aspirin was added, replaced by heparin in the pre-partum period. In the case of antiphospholipid syndrome complicated by previous throm botic events or fetal losses despite aspirin, heparin was prescribed. One woman with a history of atrioventricular block was treated with de xamethasone. Patients were monitored by medical and obstetrical examin ation, and laboratory tests carried out at least monthly and a quarter ly echography. Among 62 pregnancies in 38 women, lupus flare was obser ved in 27% of the cases, 6% of which occurred in the post-partum perio d. Flares were moderate except in one renal involvement in a woman wit h prior diffuse proliferative glomerulonephritis. Therapy was not modi fied in half of the cases. Pregnancy ended in early spontaneous aborti on not related to lupus flare (n = 10), stillbirth (n = 2), induced ab ortion (n = 2), preterm birth (n = 29) and full-term birth (n = 19). C aesarean section was performed in nine cases. A severe infection occur red in two premature neonates. Another premature neonate was growth re tarded. Two children had cutaneous neonatal lupus. No child died, neit her had atrioventricular block. Stillbirth and severe prematurity were more common in mothers with antiphospholipid syndrome. After exclusio n of early spontaneous and induced abortions, the live birth rate was 96%, that is close to the French general population. The main problem remains a high rate of prematurity, but without maternal or neonatal d eath.