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Original Article
DOI: 10.1016/j.reumae.2021.02.008
Available online 18 September 2021
Is lupus nephritis a prognosis factor for pregnancy? Maternal and foetal outcomes
¿Es la nefritis lúpica un factor pronóstico en el embarazo? Resultados maternos y fetales
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Cintia Otaduyc, Carla Andrea Gobbic,d, Alejandro Álvareza, Eduardo Horacio Albierob, Marcelo Augusto Yoriob,c, Paula Alba Moreyraa,b,c,
Corresponding author
paulaalba@yahoo.com

Corresponding author.
a Hospital Materno Neonatal de la Provincia de Córdoba, Córdoba, Argentina
b Hospital Córdoba, Córdoba, Argentina
c Cátedra de Semiología, Hospital Córdoba, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
d Cátedra de Clínica Médica I, Hospital Córdoba, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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Tables (6)
Table 1. Maternal, demographic, clinical and serological characteristics.
Table 2. Medical treatment during pregnancy.
Table 3. Lupus activity according to SELENA SLEDAI in pregnancy.
Table 4. Maternal outcomes.
Table 5. Foetal outcomes.
Table 6. Completion of pregnancy.
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Abstract
Background

Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications.

Objective

To evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome.

Methods

We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated.

Results

121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had Class IV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P = .041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P = .047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress.

Conclusions

Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.

Keywords:
Systemic lupus erythematosus
Lupus nephritis
Pregnancy
Foetal outcome
Resumen
Introducción

La preexistencia de nefritis lúpica (NL) es un factor de riesgo importante al planificar un embarazo debido al riesgo de complicaciones.

Objetivo

Evaluar complicaciones maternas y fetales en la gestación de mujeres con lupus eritematoso sistémico (LES) con y sin NL previa a la concepción.

Métodos

Se estudiaron retrospectivamente todas las pacientes lúpicas embarazadas con y sin NL previa, asistidas desde enero de 2015 hasta abril de 2017. Se analizaron datos demográficos, clínicos y de laboratorio, presencia de anticuerpos antifosfolípidos (AAF) y síndrome antifosfolípido (SAF) según criterios de Sydney, resultados maternos y fetales.

Resultados

Se incluyeron 79 pacientes, 40 con NL previa y 39 sin NL, sumando 121 embarazos (52 sin NL y 69 con NL). El grupo NL registró mayor porcentaje de presencia de AAF, SAF y mayor SLEDAI basal, además recibieron más terapia inmunosupresora y corticoidea. En NL fue más frecuente la clase IV (47,5%): 25,8% en el grupo NL vs 10,9% (p = 0,041) tuvieron reactivaciones, especialmente renales, sin desarrollo de enfermedad renal terminal. La preeclampsia fue mayor en el grupo con NL: 18,8% vs 6,3% sin NL (p = 0,047). Registramos una muerte materna en el grupo NL. La vía de finalización fue cesárea (68,5% en el grupo NL y 31,5% en grupo sin NL), siendo más frecuente de urgencia en el grupo con NL. En resultados fetales, no hubo diferencia en porcentaje de nacidos vivos, peso del neonato ni edad gestacional. Se registraron 3 muertes fetales: 2 en el grupo con NL y 1 en el otro.

Conclusión

Las pacientes con NL sufrieron más complicaciones maternas como brote lúpico y preeclampsia. Sin embargo, la NL no conduciría a peores resultados obstétricos ni fetales.

Palabras clave:
Lupus eritematoso sistémico
Nefritis lúpica
Embarazo
Pronostico materno fetal

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