FRI0393 Maternal and fetal outcomes in systemic lupus erythematosus
Authors: I.Y. Yii, L. Yang, H.K. Tan, L.K. Tan, J. Thumboo, Y.J. Poh
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Systemic Lupus Erythematosus (SLE) is associated with an increased risk of adverse pregnancy outcomes. <h3>Objectives</h3> We aim to evaluate the maternal and fetal outcomes in SLE pregnancies in a single tertiary referral centre. <h3>Methods</h3> We retrospectively analysed 75 pregnancies in 45 patients with SLE over a 16 year period from 2000 to 2016. All patients fulfilled the 1997 American College of Rheumatology (ACR) criteria or the Systemic Lupus International Collaborating Clinics (SLICC) criteria for diagnosis of SLE. <h3>Results</h3> In our multi-ethnic cohort, there were 65% Chinese, 23% Malays and 7% Indians. The mean age was 32 years old and majority (55%) were nulliparous. The mean SLE disease duration was 5.9 years. Baseline SLE manifestations were predominantly haematological (73%), arthritis (71%) and renal (57%). There were 33 pregnancies (44%) with anti-Ro (SS-A) antibody positivity. There were 9 pregnancies (12%) with SLE and antiphospholipid syndrome. In our cohort, the majority of the patients were on prednisolone (76%). Half of the patients (48%) were on hydroxychloroquine or chloroquine and 27% were on azathioprine. In the subgroup of patients with SLE and antiphospholipid syndrome, 67% (6/9 pregnancies) were treated with therapeutic clexane and 33% (3 pregnancies) with the combination of prophylactic clexane and aspirin. The mean SELENA-SLEDAI score at the booking visit was 4.0. In our cohort, the live birth rate was 75%. More than half of the deliveries were via Caesarean section (57%). There were maternal and fetal complications in 61% of the pregnancies. Pregnancy losses occurred in 16 pregnancies with the majority (87%) being early pregnancy losses that occurred prior to 13 weeks gestation. There were 13 pregnancies (17%) with intrauterine growth restriction and 18 pregnancies (24%) with preterm delivery. In the subgroup of the preterm births, 2 were extremely preterm birth (&lt;28 weeks gestation) and 2 were very preterm birth (28 weeks to &lt;32 weeks gestation). There were no cases of congenital heart block or neonatal lupus. There was one neonatal death. SLE flares occurred in 25 pregnancies (33%). The most common organ involvement were haematological (44%), renal (40%), mucocutaneous (28%) and arthritis (16%) Pre-eclampsia occurred in 2 pregnancies (2%). There were 3 cases of a first presentation of lupus nephritis in pregnancy. In the subgroup of SLE pregnancies with antiphospholipid syndrome, there were higher SLE flare rates (44%) and more adverse pregnancy outcomes with 3 pregnancies (33%) that resulted in miscarriages, 2 pregnancies (22%) with preterm delivery and one pregnancy (11%) complicated by pre-eclampsia (table 1). There were 7% of pregnancies with a post-partum SLE flare. <h3>Conclusions</h3> In our multi-ethnic cohort, more than half of the patients experienced an adverse pregnancy outcome. SLE flares in pregnancy occurred in a third of the cohort with the most common organ manifestation being haematological and renal flares. SLE pregnancies with antiphospholipid syndrome appeared to be associated with a higher risk of SLE flares and adverse pregnancy outcomes. <h3>Disclosure of Interest</h3> None declared