AB0561 RISK FACTORS FOR ADVERSE PREGNANCY OUTCOMES AND LOW RISK FACTORS FOR ADVERSE PREGNANCY OUTCOMES AND LOW APGAR SCORES OF NEWBORNS IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Hiromi Shimada, Risa Wakiya, Mai Mahmoud Fahmy Mansour, Shusaku Nakashima, Mikiya Kato, Taichi Miyagi, Tomohiro Kameda, Hiroaki Dobashi
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Systemic lupus erythematosus (SLE) is an autoimmune disease that occurs in women of childbearing age, and has high risk for adverse pregnancy outcomes (APOs) (1,2). Moreover, it is unclear whether maternal SLE influences the growth and development of children born from SLE mothers. Apgar scores at five minutes is a predictive factor of neurological development of newborns. However, there is no report about the association between maternal SLE and Apgar score of newborns. <h3>Objectives:</h3> The aim of this study was to identify risk factors for APOs and for low Apgar scores of newborns from SLE mothers. <h3>Methods:</h3> We investigated 50 SLE patients who were delivered from May 2006 to December 2018 in our institution. We examined retrospectively regarding APOs including spontaneous abortions, preterm births, premature rupture of membranes (PROM), light-for-date (LFD) newborns, and low Apgar scores of newborns. We analyzed the association between disease activity, laboratory findings, treatment agents, and APOs or Apgar scores. <h3>Results:</h3> As for APOs of SLE mothers, cases with preterm births showed higher SLE disease activity index (SLEDAI) during the first trimester (P = 0.01) and higher titers of anti-double-stranded DNA (anti-dsDNA) antibodies at the time of conception (P &lt; 0.01) compared to full-term births. In these cases, mean glucocortitcoid doses during pregnancy (P = 0.02) and the rate of treatment intensification (P &lt; 0.01) was higher than full-term birth. In the mothers who delivered LFD newborns, serum complement levels at conception were lower than in those with non-LFD newborns (C3: P = 0.02; CH50: P = 0.05). Cases with spontaneous abortions and PROMs did not differ significantly from the cases without spontaneous abortions and PROMs. Apgar scores at one minute were correlated with SLEDAI during the third trimester (P &lt; 0.01) and with the titer of anti-dsDNA antibodies at conception (P &lt; 0.01). Additionally, Apgar scores at five minutes were correlated with the titer of anti-dsDNA antibodies (P &lt; 0.01). In multivariate analysis, there were significant association between Apgar scores at five minutes and the titer of anti-dsDNA antibodies (P &lt; 0.01, Table 1). <h3>Conclusion:</h3> In SLE, immunological abnormalities at conception, high SLEDAI and glucocorticoid doses were risk factors for preterm birth and having a LFD newborn. Apgar scores at five minutes were significantly associated with the titer of anti-dsDNA antibodies. Minimizing disease activity before pregnancy may decrease risks for mothers and their newborns. In preconception counseling, it is important for rheumatologists to explain these risk factors to patients with SLE who hope to conceive. There is a need for long-term follow-up studies focusing on the neurological development of children born from SLE mothers. <h3>References</h3> [1] Clowse ME, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 2008;199:127.e1-6. [2] Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: a meta-analysis of studies published between years 2001–2016. J Autoimmun 2017;79:17-27. <h3>Disclosure of Interests:</h3> None declared