Publication:

A retrospective observational study of predictors of adverse maternal and fetal outcomes in mothers with systemic lupus erythematosus in pregnancy

Background SLE is a disease of reproductive age group and has implications on maternal and fetal health in pregnancy. This study was done to determine and analyze the predictors of adverse maternal and fetal outcomes in mothers with systemic lupus erythematosus in pregnancy.

Methods Retrospective observational study was done to evaluate pregnancy outcomes in SLE mothers at Fernandez Hospital, Hyderabad, from January 2017 to December 2022. Data was obtained via electronic medical records. Descriptive analysis was done by mean and standard deviation for quantitative variables, and frequency and proportion for categorical variables. Chi-square test was used to test statistical significance between variables (p<0.05 was significant).

Results SLE affects pregnancies causing adverse maternal (flares (18.95%), hypertensive disorders (22.18%), severe maternal morbidity (5.65%), fetal (preterm birth (38.71%), FGR (28.97%), perinatal death (3.17%)), and neonatal (congenital heart block (3.17%), neonatal lupus (3.96%), Binder’s facies (5.16%)) outcomes- especially when period of remission was <6 months (p<0.05). Anti-Smith, RNP and Scl-70 Ab were significantly associated with Binder’s facies and chondrodysplasia. Anti-Ro/La antibodies were associated with congenital heart block and endocardial fibroelastosis. Lupus nephritis was an independent risk factor for adverse outcomes. Chronic hypertension, past history of thrombosis and chronic kidney disease were risk factors for adverse outcomes (p<0.05). Heparin, HCQs and Azathioprine could also have a role in improving perinatal outcomes (p<0.05).

Conclusions As SLE can cause adverse maternal, fetal and perinatal outcomes in pregnancy, all mothers with SLE should undergo preconceptional counselling to optimize outcomes.