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2016 ; 68
(7
): 988-94
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What to Expect When Expecting With Systemic Lupus Erythematosus (SLE): A
Population-Based Study of Maternal and Fetal Outcomes in SLE and Pre-SLE
#MMPMID27338103
Arkema EV
; Palmsten K
; Sjöwall C
; Svenungsson E
; Salmon JE
; Simard JF
Arthritis Care Res (Hoboken)
2016[Jul]; 68
(7
): 988-94
PMID27338103
show ga
OBJECTIVE: To assess maternal and fetal outcomes associated with subclinical
(pre-systemic lupus erythematosus [SLE] and SLE presenting up to 5 years
postpartum) and prevalent maternal SLE during pregnancy compared with the general
population. METHODS: This prospective cohort study used population-based Swedish
registers to identify 13,598 women with first singleton pregnancies registered in
the Medical Birth Register (551 prevalent SLE, 65 pre-SLE within 0-2 years, 133
pre-SLE within 2-5 years, and 12,847 general population). SLE was defined as ?2
SLE-coded discharge diagnoses in the patient register with ?1 diagnosis from a
specialist. Unadjusted risks of adverse pregnancy or birth outcomes were
calculated by SLE status, and Cochran-Armitage tests evaluated trend across
exposure groups. RESULTS: Maternal outcomes such as preeclampsia, hypothyroidism,
stroke, and infection were more common among women with SLE. Sixteen percent of
prevalent-SLE pregnancies were diagnosed with preeclampsia compared with 5% of
those from the general population. Among the pre-SLE women, preeclampsia was
found in 26% of those with SLE within 2 years postpartum and 13% in those with
SLE within 2-5 years postpartum. Similarly, infant outcomes, such as preterm
birth, infection, and mortality, were worse among those born to mothers with
prevalent SLE and pre-SLE during pregnancy. The test for trend was significant
for most outcomes. CONCLUSION: Our data demonstrate that adverse maternal and
fetal outcomes are more common in SLE pregnancies. Furthermore, these unfavorable
outcomes are observed in pregnancies occurring prior to the diagnosis of SLE.
Thus, the underlying immunologic profile of SLE and alterations preceding
clinical SLE may contribute to these pregnancy complications.