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SİSTEMİK LUPUS ERİTEMATOZUSLU GEBE KADINLARIN MATERNAL VE FETAL SONUÇLARININ DEĞERLENDİRİLMESİ

Year 2021, Volume: 18 Issue: 4, 1056 - 1061, 31.12.2021
https://doi.org/10.38136/jgon.981014

Abstract

Amaç: Bu çalışmada sistemik lupus eritematozuslu (SLE) gebelerin obstetrik ve perinatal sonuçlarını değerlendirmeyi amaçladık.
Gereçler ve yöntem: Bu çalışma 2010-2020 yılları arasında 35 SLE hastasının obstetrik sonuçlarını değerlendiren retrospektif bir çalışmadır. Lupus aktivitesi SLE Hastalık Aktivite İndeksi (SLEDAI) kriterlerine göre yapılmış ve gebelik sonuçları aktif ve inaktif SLE olarak gruplandırılarak değerlendirilmiştir.
Bulgular: Ortalama maternal yaş 29 (21-39) idi. Antifosfolipid sendromu ve aktif hastalık oranı sırasıyla %5 ve %40 idi. 30 canlı doğum oldu. Biri majör kardiyak anomalili, diğeri renal agenezili olmak üzere iki gebelik terminasyonu rapor edildi. Aktif SLE grubunda bir spontan abortus ve 2 ölü doğum gözlendi. İntrauterin büyüme geriliği, preeklampsi ve erken doğum oranları sırasıyla %8, %20 ve %26 idi. Aktif SLE grubunda fetal kayıp ve erken doğum anlamlı olarak daha yüksekti (p=0,018, p=0,023). Aktif SLE grubunda daha yüksek yenidoğan yoğun bakım ünitesine (YYBB) yatış oranı gözlendi (p=0,034) ancak Apgar skorları <8 ve umbilikal kord kanı pH'ı gruplar arasında benzerdi (p>0,05).
Sonuç: Bilimdeki gelişmelere rağmen, aktif SLE hastalığının, olumsuz gebelik sonuçlarına yol açma riski yüksektir. Yakın takip, özellikle erken doğumlar başta olmak üzere gebelik komplikasyonlarını azaltmaya yardımcı olabilir.

Supporting Institution

YOK

References

  • 1. Lateef A, Petri M. Managing lupus patients during pregnancy [Internet]. Vol. 27, Best Practice and Research: Clinical Rheumatology. Bailliere Tindall Ltd; 2013 [cited 2021 May 23]. p. 435–47. Available from: https://pubmed.ncbi.nlm.nih.gov/24238698/
  • 2. Cortes-Hernandez J, Ordi-Ros J, Paredes F, Casellas M, Castillo F, Vilardell-Tarres M. Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: A prospective study of 103 pregnancies. Rheumatology [Internet]. 2002 [cited 2021 May 23];41(6):643–50. Available from: https://pubmed.ncbi.nlm.nih.gov/12048290/
  • 3. Clowse MEB, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis and Rheumatism [Internet]. 2005 Feb [cited 2021 May 23];52(2):514–21. Available from: https://pubmed.ncbi.nlm.nih.gov/15692988/
  • 4. Yamamoto Y, Aoki S. Systemic lupus erythematosus: Strategies to improve pregnancy outcomes [Internet]. Vol. 8, International Journal of Women’s Health. Dove Medical Press Ltd; 2016 [cited 2021 May 23]. p. 265–72. Available from: /pmc/articles/PMC4944915/
  • 5. Buyon JP, Kim MY, Guerra MM, Lu S, Reeves E, Petri M, et al. Kidney outcomes and risk factors for nephritis (flare/de novo) in a multiethnic cohort of pregnant patients with lupus. Clinical Journal of the American Society of Nephrology [Internet]. 2017 [cited 2021 May 23];12(6):940–6. Available from: https://pubmed.ncbi.nlm.nih.gov/28400421/
  • 6. Smyth A, Oliveira GHM, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clinical Journal of the American Society of Nephrology [Internet]. 2010 Nov 1 [cited 2021 May 23];5(11):2060–8. Available from: https://pubmed.ncbi.nlm.nih.gov/20688887/
  • 7. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). Journal of Thrombosis and Haemostasis [Internet]. 2006 Feb [cited 2021 May 29];4(2):295–306. Available from: https://pubmed.ncbi.nlm.nih.gov/16420554/
  • 8. Chen YJ, Chang JC, Lai EL, Liao TL, Chen HH, Hung WT, et al. Maternal and perinatal outcomes of pregnancies in systemic lupus erythematosus: A nationwide population-based study. Seminars in Arthritis and Rheumatism [Internet]. 2020 Jun 1 [cited 2021 May 28];50(3):451–7. Available from: https://pubmed.ncbi.nlm.nih.gov/32115237/
  • 9. Liu J, Zhao Y, Song Y, Zhang W, Bian X, Yang J, et al. Pregnancy in women with systemic lupus erythematosus: A retrospective study of 111 pregnancies in Chinese women. Journal of Maternal-Fetal and Neonatal Medicine [Internet]. 2012 Mar [cited 2021 May 28];25(3):261–6. Available from: https://pubmed.ncbi.nlm.nih.gov/21504337/
  • 10. Clowse MEB, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. American Journal of Obstetrics and Gynecology [Internet]. 2008 [cited 2021 May 28];199(2):127.e1-127.e6. Available from: https://pubmed.ncbi.nlm.nih.gov/18456233/
  • 11. Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis and Rheumatism [Internet]. 2006 Mar [cited 2021 May 28];54(3):899–907. Available from: https://pubmed.ncbi.nlm.nih.gov/16508972/
  • 12. Piccoli GB, Cabiddu G, Attini R, Vigotti FN, Maxia S, Lepori N, et al. Risk of adverse pregnancy outcomes in women with CKD. Journal of the American Society of Nephrology [Internet]. 2015 Aug 1 [cited 2021 May 29];26(8):2011–22. Available from: https://pubmed.ncbi.nlm.nih.gov/25766536/
  • 13. Buyon JP, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, et al. Predictors of pregnancy outcomes in patients with lupus: A cohort study. Annals of Internal Medicine [Internet]. 2015 Aug 4 [cited 2021 May 29];163(3):153–63. Available from: https://pubmed.ncbi.nlm.nih.gov/26098843/
  • 14. Smyth A, Radovic M, Garovic VD. Women, kidney disease, and pregnancy [Internet]. Vol. 20, Advances in Chronic Kidney Disease. Adv Chronic Kidney Dis; 2013 [cited 2021 May 29]. p. 402–10. Available from: https://pubmed.ncbi.nlm.nih.gov/23978545/
  • 15. Kalok A, Abdul Cader R, Indirayani I, Abdul Karim AK, Shah SA, Mohamed Ismail NA, et al. Pregnancy outcomes in systemic lupus erythematosus (SLE) women. Hormone Molecular Biology and Clinical Investigation [Internet]. 2019 [cited 2021 May 31];40(3). Available from: https://pubmed.ncbi.nlm.nih.gov/31553696/
  • 16. Pastore DEA, Costa ML, Surita FG. Systemic lupus erythematosus and pregnancy: the challenge of improving antenatal care and outcomes. Lupus [Internet]. 2019 Oct 1 [cited 2021 May 31];28(12):1417–26. Available from: https://pubmed.ncbi.nlm.nih.gov/31551036/
  • 17. Georgiou PE, Politi EN, Katsimbri P, Sakka V, Drosos AA. Outcome of lupus pregnancy: A controlled study. Rheumatology [Internet]. 2000 [cited 2021 May 31];39(9):1014–9. Available from: https://pubmed.ncbi.nlm.nih.gov/10986308/
  • 18. Cortes-Hernandez J, Ordi-Ros J, Paredes F, Casellas M, Castillo F, Vilardell-Tarres M. Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: A prospective study of 103 pregnancies. Rheumatology [Internet]. 2002 [cited 2021 May 31];41(6):643–50. Available from: https://pubmed.ncbi.nlm.nih.gov/12048290/
  • 19. Clowse MEB, Magder LS, Petri M. The clinical utility of measuring complement and anti-dsDNA antibodies during pregnancy in patients with systemic lupus erythematosus. Journal of Rheumatology [Internet]. 2011 Jun [cited 2021 May 31];38(6):1012–6. Available from: https://pubmed.ncbi.nlm.nih.gov/21406496/
  • 20. al Arfaj AS, Khalil N. Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus [Internet]. 2010 Dec [cited 2021 May 31];19(14):1665–73. Available from: https://pubmed.ncbi.nlm.nih.gov/20947541/
  • 21. Martínez-Sánchez N, Pérez-Pinto S, Robles-Marhuenda Á, Arnalich-Fernández F, Martín Cameán M, Hueso Zalvide E, et al. Obstetric and perinatal outcome in anti-Ro/SSA-positive pregnant women: a prospective cohort study. Immunologic Research. 2017 Apr 1;65(2):487–94.
  • 22. Izmirly P, Saxena A, Buyon JP. Progress in the pathogenesis and treatment of cardiac manifestations of neonatal lupus [Internet]. Vol. 29, Current Opinion in Rheumatology. Lippincott Williams and Wilkins; 2017 [cited 2021 May 31]. p. 467–72. Available from: https://pubmed.ncbi.nlm.nih.gov/28520682/
  • 23. LeFevre ML. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine [Internet]. 2014 Dec 2 [cited 2021 May 31];161(11):819–26. Available from: https://pubmed.ncbi.nlm.nih.gov/25200125/
  • 24. Khan A, Thomas M, Syamala Devi PK. Pregnancy complicated by systemic lupus erythematosus and its outcome over 10 years. Journal of Obstetrics and Gynaecology [Internet]. 2018 May 19 [cited 2021 Jun 1];38(4):476–81. Available from: https://pubmed.ncbi.nlm.nih.gov/29433371/

EVALUATION OF MATERNAL AND FETAL OUTCOMES OF PREGNANT WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Year 2021, Volume: 18 Issue: 4, 1056 - 1061, 31.12.2021
https://doi.org/10.38136/jgon.981014

Abstract

Aim: To evaluate obstetrical and perinatal outcomes of pregnancies with systemic lupus erythematosus (SLE).
Materials and Method: This was a retrospective study evaluating obstetric outcomes of 35 patients with SLE who were followed up between 2010 and 2020. Lupus activity was based on SLE Disease Activity Index (SLEDAI) criteria and pregnancy outcomes were evaluated by grouping as active and inactive SLE.
Results: The mean maternal age was 29 (21-39). The rate of antiphospholipid syndrome and active disease was 5% and 40% respectively. There were 30 live births. Two elective abortions were reported, one with major cardiac anomaly and the other with renal agenesis. One spontaneous abortion and 2 stillbirths were observed in the active SLE group. Overall rates of intrauterine growth retardation, preeclampsia, and preterm delivery were 8%, 20%, and 26%, respectively. Fetal loss and preterm delivery were significantly higher in the active SLE group (p=0,018, p=0,023). A higher rate of neonatal intensive care unit (NICU) admission was observed in the active SLE group (p=0,034) but Apgar scores less than <8 and umbilical cord pH were similar between groups (p>0,05).
Conclusion: Despite advances in the medical sciences, an active disease with SLE has an elevated risk of inducing adverse pregnancy outcomes. Close follow-up could helps reduce pregnancy complications, especially preterm deliveries.

References

  • 1. Lateef A, Petri M. Managing lupus patients during pregnancy [Internet]. Vol. 27, Best Practice and Research: Clinical Rheumatology. Bailliere Tindall Ltd; 2013 [cited 2021 May 23]. p. 435–47. Available from: https://pubmed.ncbi.nlm.nih.gov/24238698/
  • 2. Cortes-Hernandez J, Ordi-Ros J, Paredes F, Casellas M, Castillo F, Vilardell-Tarres M. Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: A prospective study of 103 pregnancies. Rheumatology [Internet]. 2002 [cited 2021 May 23];41(6):643–50. Available from: https://pubmed.ncbi.nlm.nih.gov/12048290/
  • 3. Clowse MEB, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis and Rheumatism [Internet]. 2005 Feb [cited 2021 May 23];52(2):514–21. Available from: https://pubmed.ncbi.nlm.nih.gov/15692988/
  • 4. Yamamoto Y, Aoki S. Systemic lupus erythematosus: Strategies to improve pregnancy outcomes [Internet]. Vol. 8, International Journal of Women’s Health. Dove Medical Press Ltd; 2016 [cited 2021 May 23]. p. 265–72. Available from: /pmc/articles/PMC4944915/
  • 5. Buyon JP, Kim MY, Guerra MM, Lu S, Reeves E, Petri M, et al. Kidney outcomes and risk factors for nephritis (flare/de novo) in a multiethnic cohort of pregnant patients with lupus. Clinical Journal of the American Society of Nephrology [Internet]. 2017 [cited 2021 May 23];12(6):940–6. Available from: https://pubmed.ncbi.nlm.nih.gov/28400421/
  • 6. Smyth A, Oliveira GHM, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clinical Journal of the American Society of Nephrology [Internet]. 2010 Nov 1 [cited 2021 May 23];5(11):2060–8. Available from: https://pubmed.ncbi.nlm.nih.gov/20688887/
  • 7. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). Journal of Thrombosis and Haemostasis [Internet]. 2006 Feb [cited 2021 May 29];4(2):295–306. Available from: https://pubmed.ncbi.nlm.nih.gov/16420554/
  • 8. Chen YJ, Chang JC, Lai EL, Liao TL, Chen HH, Hung WT, et al. Maternal and perinatal outcomes of pregnancies in systemic lupus erythematosus: A nationwide population-based study. Seminars in Arthritis and Rheumatism [Internet]. 2020 Jun 1 [cited 2021 May 28];50(3):451–7. Available from: https://pubmed.ncbi.nlm.nih.gov/32115237/
  • 9. Liu J, Zhao Y, Song Y, Zhang W, Bian X, Yang J, et al. Pregnancy in women with systemic lupus erythematosus: A retrospective study of 111 pregnancies in Chinese women. Journal of Maternal-Fetal and Neonatal Medicine [Internet]. 2012 Mar [cited 2021 May 28];25(3):261–6. Available from: https://pubmed.ncbi.nlm.nih.gov/21504337/
  • 10. Clowse MEB, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. American Journal of Obstetrics and Gynecology [Internet]. 2008 [cited 2021 May 28];199(2):127.e1-127.e6. Available from: https://pubmed.ncbi.nlm.nih.gov/18456233/
  • 11. Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis and Rheumatism [Internet]. 2006 Mar [cited 2021 May 28];54(3):899–907. Available from: https://pubmed.ncbi.nlm.nih.gov/16508972/
  • 12. Piccoli GB, Cabiddu G, Attini R, Vigotti FN, Maxia S, Lepori N, et al. Risk of adverse pregnancy outcomes in women with CKD. Journal of the American Society of Nephrology [Internet]. 2015 Aug 1 [cited 2021 May 29];26(8):2011–22. Available from: https://pubmed.ncbi.nlm.nih.gov/25766536/
  • 13. Buyon JP, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, et al. Predictors of pregnancy outcomes in patients with lupus: A cohort study. Annals of Internal Medicine [Internet]. 2015 Aug 4 [cited 2021 May 29];163(3):153–63. Available from: https://pubmed.ncbi.nlm.nih.gov/26098843/
  • 14. Smyth A, Radovic M, Garovic VD. Women, kidney disease, and pregnancy [Internet]. Vol. 20, Advances in Chronic Kidney Disease. Adv Chronic Kidney Dis; 2013 [cited 2021 May 29]. p. 402–10. Available from: https://pubmed.ncbi.nlm.nih.gov/23978545/
  • 15. Kalok A, Abdul Cader R, Indirayani I, Abdul Karim AK, Shah SA, Mohamed Ismail NA, et al. Pregnancy outcomes in systemic lupus erythematosus (SLE) women. Hormone Molecular Biology and Clinical Investigation [Internet]. 2019 [cited 2021 May 31];40(3). Available from: https://pubmed.ncbi.nlm.nih.gov/31553696/
  • 16. Pastore DEA, Costa ML, Surita FG. Systemic lupus erythematosus and pregnancy: the challenge of improving antenatal care and outcomes. Lupus [Internet]. 2019 Oct 1 [cited 2021 May 31];28(12):1417–26. Available from: https://pubmed.ncbi.nlm.nih.gov/31551036/
  • 17. Georgiou PE, Politi EN, Katsimbri P, Sakka V, Drosos AA. Outcome of lupus pregnancy: A controlled study. Rheumatology [Internet]. 2000 [cited 2021 May 31];39(9):1014–9. Available from: https://pubmed.ncbi.nlm.nih.gov/10986308/
  • 18. Cortes-Hernandez J, Ordi-Ros J, Paredes F, Casellas M, Castillo F, Vilardell-Tarres M. Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: A prospective study of 103 pregnancies. Rheumatology [Internet]. 2002 [cited 2021 May 31];41(6):643–50. Available from: https://pubmed.ncbi.nlm.nih.gov/12048290/
  • 19. Clowse MEB, Magder LS, Petri M. The clinical utility of measuring complement and anti-dsDNA antibodies during pregnancy in patients with systemic lupus erythematosus. Journal of Rheumatology [Internet]. 2011 Jun [cited 2021 May 31];38(6):1012–6. Available from: https://pubmed.ncbi.nlm.nih.gov/21406496/
  • 20. al Arfaj AS, Khalil N. Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus [Internet]. 2010 Dec [cited 2021 May 31];19(14):1665–73. Available from: https://pubmed.ncbi.nlm.nih.gov/20947541/
  • 21. Martínez-Sánchez N, Pérez-Pinto S, Robles-Marhuenda Á, Arnalich-Fernández F, Martín Cameán M, Hueso Zalvide E, et al. Obstetric and perinatal outcome in anti-Ro/SSA-positive pregnant women: a prospective cohort study. Immunologic Research. 2017 Apr 1;65(2):487–94.
  • 22. Izmirly P, Saxena A, Buyon JP. Progress in the pathogenesis and treatment of cardiac manifestations of neonatal lupus [Internet]. Vol. 29, Current Opinion in Rheumatology. Lippincott Williams and Wilkins; 2017 [cited 2021 May 31]. p. 467–72. Available from: https://pubmed.ncbi.nlm.nih.gov/28520682/
  • 23. LeFevre ML. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine [Internet]. 2014 Dec 2 [cited 2021 May 31];161(11):819–26. Available from: https://pubmed.ncbi.nlm.nih.gov/25200125/
  • 24. Khan A, Thomas M, Syamala Devi PK. Pregnancy complicated by systemic lupus erythematosus and its outcome over 10 years. Journal of Obstetrics and Gynaecology [Internet]. 2018 May 19 [cited 2021 Jun 1];38(4):476–81. Available from: https://pubmed.ncbi.nlm.nih.gov/29433371/
There are 24 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Ezgi Turgut 0000-0002-5509-7888

Gökçe Turan 0000-0002-2443-1927

Soheil Koohnavard This is me 0000-0001-9360-517X

Hamit Küçük 0000-0003-1206-4725

Abdurrahman Tufan 0000-0001-6244-9362

Deniz Karçaaltıncaba This is me 0000-0001-5276-9303

Publication Date December 31, 2021
Submission Date August 24, 2021
Acceptance Date November 7, 2021
Published in Issue Year 2021 Volume: 18 Issue: 4

Cite

Vancouver Turgut E, Turan G, Koohnavard S, Küçük H, Tufan A, Karçaaltıncaba D. EVALUATION OF MATERNAL AND FETAL OUTCOMES OF PREGNANT WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS. JGON. 2021;18(4):1056-61.