Maternal and Neonatal Outcomes in Pregnancies Complicated by Systemic Lupus Erythematosus: A Population-Based Study

Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 04/2013; 35(4):323-8. DOI: 10.1016/S1701-2163(15)30959-2
Source: PubMed
ABSTRACT
Objective:
To determine maternal and neonatal outcomes in pregnancies complicated by systemic lupus erythematosus (SLE).

Methods:
In a retrospective cohort study using the Nova Scotia Atlee Perinatal Database, 97 pregnancies in women with SLE, with 99 live births, were compared with 211 355 pregnancies in women without SLE and their 214 115 babies. All were delivered in Nova Scotia between 1988 and 2008.

Results:
In women with SLE, gestational age at birth and mean neonatal birth weight were lower (P < 0.001) than in women without SLE. On bivariate analysis, severe preeclampsia, Caesarean section, newborn resuscitation for > 3 minutes, respiratory distress syndrome, assisted ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, mild to moderate intraventricular hemorrhage, retinopathy of prematurity, and congenital heart block in neonates were significantly more frequent in the women with SLE. Logistic regression analysis identified that having SLE increased the risks of Caesarean section (OR 1.8; 95% CI 1.1 to 2.8, P = 0.005), postpartum hemorrhage (OR 2.4; 95% CI 1.3 to 4.3, P = 0.003), need for blood transfusion (OR 6.9; 95% CI 2.7 to 17, P = 0.001), postpartum fever (OR 3.2; 95% CI 1.7 to 6.1, P = 0.032), small for gestational age babies (OR 1.7; 95% CI 1.005 to 2.9, P = 0.047), and gestational age ≤ 37 weeks (OR 2.1; 95% CI 1.3 to 3.4, P = 0.001). Neonatal death was not shown to be more common in women with SLE (RR 3.05; CI 0.43 to 21.44, P = 0.28).

Conclusion:
Mothers with SLE have an increased risk of Caesarean section, postpartum hemorrhage, and blood transfusion. They are more likely to deliver premature babies, smaller babies, and babies with congenital heart block.

Full-text

Available from: Firoozeh Nili, Jun 16, 2015
APRIL JOGC AVRIL 2013 l 323
OBSTETRICS
Key Words: Systemic lupus erythematosus, pregnancy, newborn,
outcome
Competing interests: None declared
Received on August 2, 2011
Accepted on November 22, 2012
Maternal and Neonatal Outcomes in
Pregnancies Complicated by Systemic Lupus
Erythematosus: A Population-Based Study
Firouzeh Nili, MD,
1
Lynne McLeod, MD,
2
Colleen O’Connell, PhD,
3
Evelyn Sutton, MD,
4
Douglas McMillan, MD
5
1
Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
2
Department of Obstetrics and Gynecology, Dalhousie University, Halifax NS
3
Perinatal Epidemiology Research Unit, Dalhousie University, Halifax NS
4
Department of Internal Medicine, Dalhousie University, Halifax NS
5
Department of Pediatrics, Dalhousie University, Halifax NS
J Obstet Gynaecol Can 2013;35(4):323–328
Abstract
Objective: To determine maternal and neonatal outcomes in
pregnancies complicated by systemic lupus erythematosus (SLE)
Methods: In a retrospective cohort study using the Nova Scotia Atlee
Perinatal Database, 97 pregnancies in women with SLE, with 99
live births, were compared with 211 355 pregnancies in women
without SLE and their 214 115 babies All were delivered in Nova
Scotia between 1988 and 2008
Results: In women with SLE, gestational age at birth and mean
neonatal birth weight were lower (P < 0001) than in women without
SLE On bivariate analysis, severe preeclampsia, Caesarean
section, newborn resuscitation for > 3 minutes, respiratory distress
syndrome, assisted ventilation, bronchopulmonary dysplasia, patent
ductus arteriosus, mild to moderate intraventricular hemorrhage,
retinopathy of prematurity, and congenital heart block in neonates
were signicantly more frequent in the women with SLE
Logistic regression analysis identied that having SLE increased the
risks of Caesarean section (OR 18; 95% CI 11 to 28, P = 0005),
postpartum hemorrhage (OR 24; 95% CI 13 to 43, P = 0003),
need for blood transfusion (OR 69; 95% CI 27 to 17, P = 0001),
postpartum fever (OR 32; 95% CI 17 to 61, P = 0032), small for
gestational age babies (OR 17; 95% CI 1005 to 29, P = 0047),
and gestational age ≤ 37 weeks (OR 21; 95% CI 13 to 34,
P = 0001) Neonatal death was not shown to be more common
in women with SLE (RR 305; CI 043 to 2144, P = 028)
Conclusion: Mothers with SLE have an increased risk of Caesarean
section, postpartum hemorrhage, and blood transfusion They are
more likely to deliver premature babies, smaller babies, and babies
with congenital heart block
Résumé
Objectif : Déterminer les issues maternelles et néonatales dans les
cas de grossesse compliquée par le lupus érythémateux disséminé
(LED)
Méthodes : Dans le cadre d’une étude de cohorte rétrospective
menée au moyen de la Nova Scotia Atlee Perinatal Database,
97 grossesses chez des femmes présentant le LED (ayant
donné lieu à 99 naissances vivantes) ont été comparées à
211 355 grossesses chez des femmes ne présentant pas le LED
(ayant donné lieu à 214 115 naissances vivantes) Toutes ces
femmes ont accouché en Nouvelle-Écosse entre 1988 et 2008
Résultats : Chez les femmes présentant le LED, l’âge gestationnel à
la naissance et le poids de naissance moyen étaient inférieurs (P <
0,001) à ceux qui ont été constatés chez les femmes ne présentant
pas le LED Dans le cadre de l’analyse bivariée, nous avons consta
que la prééclampsie grave, la césarienne, la réanimation néonatale
menée pendant > 3 minutes, le syndrome de détresse respiratoire, la
ventilation assistée, la dysplasie bronchopulmonaire, la persistance
du canal artériel, l’hémorragie intraventriculaire allant de légère
à modérée, la rétinopathie des prématurés et le bloc cardiaque
congénital chez les nouveau-nés étaient considérablement plus
fréquents chez les femmes présentant le LED
L’analyse par régression logistique a déterminé que le fait de
présenter le LED entraînait une hausse des risques de césarienne
(RC, 1,8; IC à 95 %, 1,1 - 2,8, P = 0,005), d’hémorragie postpartum
(RC, 2,4; IC à 95 %, 1,3 - 4,3, P = 0,003), de voir une transfusion
sanguine s’avérer nécessaire (RC, 6,9; IC à 95 %,
2,7 - 17, P = 0,001), de èvre puerpérale (RC, 3,2; IC à 95 %,
1,7 - 6,1, P = 0,032), d’hypotrophie fœtale (RC, 1,7; IC à 95 %,
1,005 - 2,9, P = 0,047) et de constater un âge gestationnel
≤ 37 semaines (RC, 2,1; IC à 95 %, 1,3 - 3,4, P = 0,001) Il n’a pas
été démontré que le décès néonatal était plus courant chez les
femmes présentant le LED (RR, 3,05; IC 0,43 - 21,44, P = 0,28)
Conclusion : Les mères présentant le LED sont exposées à un risque
accru de césarienne, d’hémorragie postpartum et de transfusion
sanguine Elles sont plus susceptibles d’accoucher d’enfants
prématurés, plus petits que la normale et présentant un bloc
cardiaque congénital
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INTRODUCTION
S
ystemic lupus erythematosus is an autoimmune disease
with a lifetime incidence in white women of 1 in 700.
1
Specic factors such as active disease during pregnancy, renal
involvement, antiphospholipid antibodies, hypertension,
and antibodies to Ro/SSA and La/SSB are associated with
unfavourable maternal and neonatal outcomes.
2,3
Treatment required for SLE such as glucocorticoids may
increase the risk of gestational diabetes, preeclampsia, and
fetal growth impairment during pregnancy.
2,4
Consumption
of low-dose acetylsalicylic acid is considered safe in
pregnancy and appears to improve fetal outcome, but
higher doses of non-steroidal anti-inammatory drugs
have the potential to cause premature closure of the ductus
arteriosus, persistent fetal circulation, fetal renal impairment,
and necrotizing enterocolitis.
2
A review of current literature reveals that pregnancies
in women with SLE are associated with increased rates
of stillbirth, fetal death prior to 20 weeks’ gestation,
prematurity, intrauterine growth retardation, and neonatal
complications such as neonatal lupus erythematosus.
5
NLE
is a rare syndrome characterized by fetal and neonatal
congenital heart block that may also occur with subacute
lupus erythematosus skin lesions, thrombocytopenia,
anemia, hepatitis, glomerulonephritis, and neurologic
involvement.
6–8
Few studies have focused on neonatal
outcomes, such as the effects of SLE and related drug
therapy on the rates of respiratory distress syndrome,
intraventricular hemorrhage, patent ductus arteriosus,
persistent fetal circulation, necrotizing enterocolitis, sepsis,
and retinopathy of prematurity.
Using the Nova Scotia Atlee Perinatal Database, we
compared maternal and neonatal outcomes in pregnancies
complicated by clinically diagnosed SLE with those of
the remaining Nova Scotia population without the clinical
diagnosis of SLE delivered between 1988 and 2008.
MATERIAL AND METHODS
Information for the study was obtained from the Nova
Scotia Attlee Perinatal Database, which contains detailed
information on maternal characteristics, labour and delivery
events, neonatal diagnoses, and procedures for all women
who give birth in Nova Scotia and, where possible, for those
women from Nova Scotia who deliver outside the province.
Information in the database was collected from antenatal
records and medical charts by trained personnel using
standardized forms. An ongoing data quality assurance
program, which conducts periodic abstraction and validation
studies, has shown that the data are accurate and reliable.
9
We used the database to identify pregnancies complicated
by SLE for the study group and pregnancies without the
diagnosis of SLE for the comparison group. We used codes
from the database, version 13.0.0, with the denition of SLE
based on documentation in the patient’s record. All women
with the diagnosis of SLE were used as the study population.
The comparison group included all other pregnant women
without identied rheumatologic disease who delivered
between January 1, 1988, and December 31, 2008.
Analysis of the data was performed using SAS version 8 (SAS
Institute, Cary, NC) and SPSS version 15 (IBM Corp., Armonk
NY) software. Continuous variables were analyzed using the
Student t test, and categorical variables were analyzed using
the chi-square test (with Fisher exact test where appropriate).
Logistic regression for maternal and neonatal outcome
variables included all with a P value < 0.05 on bivariate analysis.
A P value of < 0.05 was considered statistically signicant.
Odds ratios with corresponding 95% condence intervals
were calculated for dichotomous variables.
As some women in the cohort had several pregnancies
during the study period, the statistical signicance of
observed differences was assessed using a generalized
estimating equations approach. Adjusted estimates of odds
ratios were calculated using binary regression with a log link.
Ethics approval for the study was provided by the IWK
Health Centre Research Ethics Board.
RESULTS
Of 211 452 women, there were 97 pregnancies in 77
patients with SLE (the SLE group) during the study
period. Among 99 neonates in the SLE group, there were
52 males (52.5%)
and 47 females (47.5%), a ratio that was
not different from the non-SLE group (P = 0.7). Ninety-
three of the 97 pregnancies in the SLE group (96.9 %) were
singletons (not different from non-SLE; P = 0.12). Forty-
four women (45.8%) were nulliparous, similar to the 44.7%
non-SLE mothers (P = 0. 8). On bivariate analysis, there
were differences in mean maternal age (SLE: 29.8 ± 4.9
years, non-SLE: 28.2 ± 5.4 years), median gravidity (SLE 2
ABBREVIATIONS
CHB congenital heart block
ITP idiopathic thrombocytopenic purpura
NLE neonatal lupus erythematosus
PIH pregnancy induced hypertension
SLE systemic lupus erythematosus
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Maternal and Neonatal Outcomes in Pregnancies Complicated by Systemic Lupus Erythematosus: A Population-Based Study
[range 1 to 8], non-SLE 1 [range 1 to 21]), mean birth weight
(SLE 3117 ± 700 g, non-SLE 3431 ± 62 g), mean gestational
age (SLE 38.2 ± 2.6 weeks, non-SLE 39.1 ± 2.1 weeks),
median one-minute Apgar score (SLE 9 [range 1 to 9], non-
SLE 9 [range 0 to 10]), mean maternal hospital stay (SLE
4.6 ± 3.3 days, non-SLE 3.1 ± 1.6 days), and mean neonatal
hospital stay (SLE 8.5 ± 20.0 days, non-SLE 4.0 ± 8.2 days).
As shown in Table 1, signicant complications in the past
history of mothers with SLE included higher rates of
pregnancy loss and of low birth weight infants.
There was
no signicant difference in the frequency of infertility,
pregnancy induced hypertension, gestational diabetes, or
thromboembolic disease in the previous pregnancies in the
SLE and non-SLE groups. There were signicant differences
between the groups in the incidence of ITP (Note this
abbreviation has been dened) (SLE 5.2%, non-SLE 0.3%,
P < 0.001) and asthma (SLE 8.3%, non-SLE 4.2%, P < 0.04).
Eleven women with SLE (11.5%) used corticosteroids during
a previous pregnancy, ve (5.2%) used low-dose ASA, and
one used an anticoagulant (1.3%). Signicant differences in
maternal outcomes in the most recent pregnancy are shown
in Table 2. More women in the SLE group had induction of
labour (OR 1.8; 95% CI 1.19 to 2.8, P = 0.005) and delivery
by CS (OR 2.24; 95% CI 1.4 to 3.44, P < 0.001). Recorded
indications for induction of labour in the SLE group were
elective (1%), fetal growth restriction (1%), premature
rupture of membranes (1%), thrombocytopenia (1%), fetal
distress (1%), geographic (1%), oligohydramnios (2%), post-
dates (5.2%), hypertension (5.2%), and unspecied (15%).
Indications for CS included breech (9.4%), cephalopelvic
disproportion (10.4%), fetal distress (5.2%), previous CS
(7.3%), hypertension (2.1%), cord prolapse (3.1%), and
other (3.1%). None of these indications were more frequent
than in the non-SLE group.
Polyhydramnios, premature rupture of membranes,
antepartum hemorrhage, preterm premature rupture of
membranes, rupture of membranes > 24 hours, and chorio-
amnionitis were similar in the two groups. None of the
women in the SLE group had gestational diabetes, pre-
gestational diabetes, eclampsia, intrapartum hemorrhage,
placenta previa, placental abruption, sepsis, or lower urinary
tract infection.
Neonatal complications with bivariate analysis are shown
in Table 3. There were no babies with persistent fetal
circulation, necrotizing enterocolitis, or intraventricular
hemorrhage grades III and IV in the SLE group.
Among the four babies with CHB in the SLE group,
two had isolated CHB, one had CHB with arteriovenous
malformation of the lung and polymicrogyria and died in
Table 1. Complications in previous pregnancies
SLE
n = 97
n (%)
Non-SLE
n = 211 355
n (%) OR (95% CI) P
Low birth weight < 2500 grams 8 (83) 8102 (39) 21 (10 to 41) 0025
Pregnancy loss > 500 g or > 20 weeks 4 (42) 1728 (08) 48 (18 to 127) 0005
Previous fetal death 4 (42) 1788 (09) 50 (18 to 136) 001
Loss of fetus in previous pregnancy 41 (427) 54 409 (257) 21 (14 to 32) < 0001
Table 2. Maternal complications in current pregnancies
SLE
n = 97
n (%)
Non-SLE
n = 211 355
n (%) OR (95% CI) P
Chronic hypertension 3 (31) 2106 (10) 32 (10 to 101) 0072
Pregnancy induced hypertension 17 (177) 19 081 (90) 21 (12 to 36) 0003
Caesarean section 37 (385) 46 201 (219) 17 (13 to 22) < 0001
Oligohydramnios 6 (63) 3967 (19) 34 (15 to 79) 0002
Thromboemboembolic disease 2 (21) 203 (01) 2213 (54 to 904) 0004
Postpartum hemorrhage: > 500 mL after delivery 13 (135) 12 732 (60) 24 (13 to 43) 0002
Maternal fever ≥ 38ºC (during the 48 hours
after delivery)
13 (135) 6717 (32) 47 (26 to 85) < 0001
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the rst week of life, and the fourth had CHB with aortic
stenosis. Other anomalies observed in the SLE group
without CHB were inguinal hernia, agenesis and hypoplasia
of the kidney, vesicoureteral reux, bilateral cleft lip and cleft
palate, ventricular septal defect, hypoplasia of the diaphragm,
and biliary atresia; the incidence of these anomalies was not
statistically different from the incidence in the non-SLE
group. Neonatal death was not more common in the SLE
group (RR 3.05; 95% CI 0.43 to 21.44, P = 0.28).
Multivariate logistic regression analysis controlling for SLE,
parity, maternal age, asthma, ITP, maternal corticosteroid,
thromboembolism, oligohydramnios, CS, gestational age,
and birth weight showed that maternal SLE was associated
with signicant risk only for the factors shown in Table 4.
DISCUSSION
According to Statistics Canada (2006), the Nova Scotian
population included 24 175 (2.5%) Aboriginal and 878 915
non-Aboriginal people including various ethnic groups.
Visible minorities made up 4% of the population, including
2% of Black ancestry.
10
The prevalence of SLE in women in Nova Scotia whose
pregnancies had reached 20 weeks’ gestation during this
20-year period was 0.046%, similar to that reported in a
California population in 2001 (0.05%).
11
Ethnicity in that
population was different from ours; the proportion of
Black, Hispanic, and Asian women was higher than in the
Nova Scotian population. Our study provides extensive
information, especially related to neonatal outcomes.
Many differences that appeared on bivariate analysis were
no longer evident after multiple logistic regressions.
Our 20-year data review has the major strength of being a
large population-based study, but each diagnosis of SLE was
based on the patient’s record. We were unable to determine
specic organ system involvement or the severity of the
illness, but the rates of corticosteroid and low-dose ASA
use lead us to believe that the majority of women with SLE
had mild to moderate disease activity.
12
Although almost all women had access to care during
pregnancy that included fetal surveillance, it is possible
that CHB could have been missed in cases of otherwise
unexplained stillbirth. All epidemiologic studies are limited
Table 3. Neonatal outcomes
SLE
n (%)
Non-SLE
n (%) OR (95% CI) P
Small for gestational age (< 10th percentile) 17 (175) 21 194 (101) 18 (11 to 32) 0026
Apgar score < 7 (1 minute) 16 (162) 22 799 (108) 16 (09 to 27) 0082
Apgar score < 7 (5 minutes) 3 (30) 2902 (14) 22 (07 to 71) 0155
Resuscitation at delivery > 3 minutes 4 (40) 2211 (10) 403 (14 to 10) 0020
NICU admission 30 (303) 21 802 (102) 29 (22 to 40) < 0001
Complete congenital heart block 4 (40) 14 (< 01) 501 (206 to 1216) < 0001
Congenital anomalies 7 (71) 7640 (36) 21 (095 to 44) 0060
Serum bilirubin > 258 µmol/L 14 (141) 19 867 (93) 16 (09 to 28) 0095
Hemoglobin < 140 g/L (in rst week of life) 6 (61) 4581 (21) 29 (12 to 67) 0007
Platelet count < 100 000 × 10
9
/L 2 (20) 1042 (05) 42 (10 to 171) 0085
Sepsis 5 (51) 11 805 (55) 09 (03 to 22) 0840
Transient respiratory distress 10 (101) 6419 (30) 36 (18 to 69) 0001
Mild respiratory distress syndrome 1 (10) 1624 (08) 13 (018 to 95) 0500
Moderate to severe respiratory distress syndrome 4 (40) 2368 (11) 37 (13 to 102) 0025
Ventilation 5 (50) 4002 (19) 27 (11 to 68) 0019
Intermittent positive pressure ventilation 5 (50) 3105 (15) 36 (14 to 88) 0003
Surfactant 2 (20) 882 (04) 49 (12 to 202) 0063
Patent ductus arteriosus 2 (20) 604 (03) 72 (17 to 29) 0032
Intraventricular hemorrhage (I, II) 2 (20) 616 (03) 715 (176 to 290) 0034
Retinopathy of prematurity 2 (20) 543 (03) 81 (19 to 321) 0027
Brochopulmonary dysplasia 3 (30) 794 (04) 83 (26 to 26) 0006
Catheter related venous/arterial thrombosis 1 (10) 76 (00) 287 (39 to 208) 0035
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Maternal and Neonatal Outcomes in Pregnancies Complicated by Systemic Lupus Erythematosus: A Population-Based Study
in their ability to detect rare adverse events that may not
produce another recordable adverse outcome such as
death.
The higher rate of previous pregnancy loss may explain the
higher mean maternal age in women with SLE in our study.
A higher mean maternal age in the SLE group than in the
non-SLE group is consistent with the ndings in the cohort
in California,
11
although the mean age of the women in that
study was lower than in our cohort.
In 2007, Clowse indicated that the rate of preeclampsia
among pregnant women with SLE ranged from 13% to
35%.
3
Our study showed that 17.8% of pregnancies in
women with SLE were complicated by PIH. A history of
preeclampsia or renal disease, active SLE at conception,
rst pregnancy, and hypertension are also associated with
preeclampsia in pregnancies in women with SLE.
3
In
our study, rst pregnancy, greater maternal age, previous
pregnancy loss, and oligohydramnios were associated with
preeclampsia.
More frequent CS (38.5% in the SLE group vs. 21.9% in the
non-SLE group) was associated with SLE, rst pregnancy,
greater maternal age, ITP, previous pregnancy loss,
oligohydramnios, and mild to severe PIH. In another report,
one third of pregnancies in women with SLE resulted in
delivery by CS.
3
The association between SLE and postpartum hemorrhage
was reported in the California cohort,
11
but was not
evaluated by logistic regression analysis. The rate of
postpartum hemorrhage in women with SLE in our study
was higher than the rate reported in the California cohort
(13.5% vs. 5%)
11
and its risk was 2.3-fold higher than in
the comparison group. The risk factors for postpartum
hemorrhage include rst pregnancy, obesity, macrosomia,
prolonged or augmented labour, antepartum hemorrhage,
placental complications, CS, over-distended uterus, multiple
pregnancy, PIH, medication, trauma, and blood clotting
disorders.
13–15
In our study, SLE, ITP, rst pregnancy, higher
maternal age, previous pregnancy loss, and oligohydramnios
were all found to contribute to the higher rate of postpartum
hemorrhage.
We found the risk for transfusion of blood and other
products was seven times higher in women with SLE than
in control subjects. This difference persisted even with
adjustment for CS. SLE, rst pregnancy, CS, and ITP were
associated with an increased rate of blood transfusion.
Antiphospholipid antibodies (e.g., lupus anticoagulant) can
produce a prolonged partial thromboplastin time that is not
corrected with additional normal plasma but is overcome
by adding excess phospholipid or platelets.
16
A pre-existing
coagulopathy
could have explained the higher incidence of
postpartum hemorrhage and blood transfusion in women
with SLE in our study. A greater need for blood transfusion
in pregnancies in women with SLE has not been previously
reported.
Antiphospholipid antibodies, which are frequently found
in patients initially diagnosed with ITP, are associated
with thrombosis. This may suggest that antiphospholipid
antibodies confer a high risk of thrombosis in patients
with ITP, or that ITP is a rst symptom of SLE.
17
ITP,
thromboembolism, and previous pregnancy loss were risk
factors for many maternal complications in our survey.
Maternal fever during the rst 48 hours after delivery was
more common in women with SLE (3.6 times more than
control subjects). Endometritis, wound infection, mastitis,
urinary tract infection, and septic thrombophlebitis are the
chief causes of puerperal infection.
18
Our study indicated
that SLE, rst pregnancy, CS, previous pregnancy loss,
oligohydramnios, and ITP were the risk factors most
correlated with postpartum fever. Flares of SLE can occur
at any time during pregnancy, as well as in the several
months after delivery.
3
It is possible that fever was an early
sign of ares of SLE in our study.
Table 4. Risk of maternal and neonatal outcomes associated with SLE
Maternal and neonatal outcomes OR 95% CI P
Maternal
Caesarean section 18 12 to 28 0004
Postpartum hemorrhage 24 13 to 442 0003
Need for blood transfusion 709 28 to 176 < 0001
Fever (postpartum) 36 19 to 68 < 0001
Neonatal
Small for gestational age <10th percentile 18 1005 to 30 0029
Gestational age ≤ 37 weeks 24 15 to 38 < 0001
Page 5
328 l APRIL JOGC AVRIL 2013
OBSTETRICS
In pregnancies in women with SLE, the risk for preterm birth
(< 37 weeks’ gestation) is estimated to be 33%.
3
In our study
31.6% of pregnancies were preterm, which is consistent
with other reports. In the Hopkins Lupus Pregnancy
Cohort, the rate of prematurity was almost twice as high
when the disease was active (66%) as when it was inactive
(32%).
3
SLE, a history of ITP, higher maternal age, a rst
pregnancy, previous pregnancy loss, antenatal treatment with
corticosteroids, and use of low-dose ASA were associated
with preterm deliveries in our study. It is probable that ASA
was used in women with a poor pregnancy history; it is an
unexpected predictor for many adverse outcomes.
19
The use
of corticosteroids has also been proposed as a risk factor for
preterm delivery and premature rupture of membranes for
the same reason.
20
The incidence of small for gestational age in pregnancies
in women with SLE (9.4%) is comparable to the dened
incidence in the general population of 10%.
However, a
rate of 35% was reported in the Hopkins Lupus Pregnancy
Cohort.
3
The rate of SGA among the pregnancies in our
cohort with a live birth was 17.3%. We found that SLE, ITP,
rst pregnancy, thromboembolism, and previous pregnancy
loss were associated with SGA infants.
In the current study, the rate of CHB in the SLE group
was 4.1%. CHB is associated with a mortality rate of
20% to 30% in the neonatal period.
21
In our cohort, one
baby with multiple congenital anomalies including CHB,
polymicrogyria, and arteriovenous malformation of the lung
expired during the rst week of life. Boros et al.
7
suggested
that hydrocephalus and macrocephaly are manifestations
of NLE and that infants born to mothers with anti-Ro
antibodies should be carefully monitored for hydrocephalus
as part of their routine physical examination
. Among the
babies in our SLE group, one had biliary atresia that could
possibly have been related to maternal SLE. Hepatobiliary
disease is a relatively common nding in NLE and can be
the sole clinical manifestation of NLE.
8
CONCLUSION
Our population-based study provides information on
maternal and neonatal outcomes in pregnancies complicated
by SLE to assist antenatal counselling and preparation of
parents for the birth of their babies. In addition to increased
pregnancy loss, there is an increased risk of earlier delivery,
delivery by Caesarean section, postpartum hemorrhage, and
postpartum fever, and a greater need for blood transfusion,
and. In the absence of congenital heart block, adverse
outcomes for babies are related to prematurity and its
complications.
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  • Source
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