Pregnancy outcome in 69 pregnancies of multinational population in Qatar with systemic lupus erythematosus
Authors: Al-Emadi Samar 
Published: November 2013

Objective: To determine the frequencies of abnormal pregnancy outcomes in a cohort of patients in Qatar and to identify clinical and laboratory factors predicting adverse fetal and maternal outcomes with systemic lupus erythematosus in multinational population in Qatar. Study design: Data of 69 pregnancies of 37 systemic lupus erythematosus (SLE) patients from January 2005 to July 2012 in hmc analyzed retrospectively. Lupus activity was assessed based on SLE Disease Activity Index (SLEDAI) criteria. Results: Among 69 pregnancies 35 (50.7%) pregnancies were in Qatari nationals and 34 (49.3%) pregnancies were in Non-Qatari population including Asians and Africans. There were total of 69 pregnancies from 36 patients. Average numbers of pregnancies prior to and after onset of SLE were 3.73±1.8 and 2.72±1.5 respectively. Age at conception (in years) and gestational age at delivery (in weeks) were 34.5±5.4 and 37.4±2.8 respectively. Anti phospholipid antibodies (aPLs), Anti-SSA (Anti Ro) antibody and Anti SSB (Anti La) antibody were present in 18 (26.1%), 23 (33.3%), 13 (18.8%) pregnancies respectively. There were 10 (14.5%) abortions, 5 (5.7%) stillbirths, 1 neonatal death and 54 (78.3%) live births including two twin gestations. Although, not statistically significant, mean gestational age (weeks) was found to be higher in active lupus patients (37.4±1.9vs. 37.2±3.23, p=0.789) and baby weight at birth was found to be low (2.68±0.64 vs. 2.87±0.60, p=0.360) compared to patients on remission. Pregnancy induced hypertension (PIH) (17.4% vs 11.1%), intrauterine growth retardation (IUGR) (36.4% vs 11.8%), preterm delivery ([31.6 % vs 11.8%), still birth (13% Vs 5.6%) and Eclampsia (13% Vs 0%), all were observed to be higher in active lupus patients compared to patients on remission. However thees differences were not statistically significant. Compared with pregnancies without lupus nephritis (n=44), pregnancies with lupus nephritis (n=7) were associated with a higher risk of still birth (28.6% vs. 4.5%, p=0.092), higher rate of eclampsia (28.6% vs. 4.9%, p=0.103), IUGR (42.9% vs. 26.2%, p=0.626), PIH (28.6% vs. 9.8%, p=0.412). The percentage of live births was higher in pregnancies without lupus nephritis compared to pregnancies with lupus nephritis (42/44, 95.5% vs. 5/7, 71.4%, p=0.092), and live births was also significantly higher in pregnancies without eclampsia/preeclampsia compared to pregnancies with eclampsia/preeclampsia (42/42, 100% vs. 2/7, 28.6%, p<0.001), Stillbirth and preterm delivery were found to be higher in pregnancies with protinurea. Among the laboratory parameters, presence of Anti Ro antibody was found to be significantly associated with IUGR (8/18, 44.4% vs. 6/37, 16.2%, p=0.034). One case of neonatal heart block was found in which Anti Ro/La antibody was positive. Low level of C3 was associated with higher rate of stillbirth, IUGR, preterm delivery, and PIH, however, the difference were not statistically significant (p>0.05). Conclusion: SLE in pregnancy in the Qatar population were associated with higher risk adverse pregnancy outcomes. Disease activity during pregnancy, protinurea, lupus nephritis and eclampsia/preeclampsia were all negatively associated with pregnancy outcome such as IUGR, still births and preterm delivery. Laboratory parameters such as presence of Anti Ro/La antibody and low level of C3 were also associated with adverse pregnancy outcomes.