THU0273 DISEASE ACTIVITY IS IMPORTANT RISK FACTORS FOR MATERNAL AND FETAL OUTCOMES DURING PREGNANCY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: J. W. Kim, J. Y. Jung, H. A. Kim, C. H. Suh
Journal: Annals of the Rheumatic Diseases (2020)

Background: Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and disease activity frequently increase during pregnancy. Patient with SLE still have markedly higher risk for obstetric complications, despite discussing reproductive planning with physicians and choosing a suitable time for pregnancy. Objectives: This study aimed to examine the frequency and risk factors of complications occurring during pregnancy for women with SLE and compare with the general obstetric population. Methods: The medical records of patients with SLE and age-matched controls at Ajou University Hospital between January 1999 and June 2019 were collected and retrospectively analyzed. Clinical features and pregnancy complications for all pregnancy-related admissions for women with and without SLE were compared. Multivariate logistic regression analysis was performed to obtain the predictor of maternal and fetal adverse outcomes. Results: During this period, we analyzed 163 pregnancies in patients with SLE and 596 pregnancies in general population. Of these, except for body mass index (BMI), no other significant differences regarding demographic characteristics were noted between the groups. Lupus patients delivered significantly earlier(37 weeks + 0 days vs. 37 weeks + 6 days, p&lt;0.001) and experienced more stillbirth (odds ratio (OR) 12.8), pre-eclampsia (OR 4.2), preterm labor (OR 2.6), emergency cesarean section (OR 2.5) and intrauterine growth retardation (odds ratio: 2.4) than age-matched controls. Using logistic regression, thrombocytopenia, low complement levels, high proteinuria, anti-ds DNA antibody positivity and high SLE Disease Activity Index (SLEDAI) were associated with maternal and fetal complications, whereas high cumulative steroid dose after SLE onset, high median steroid dose during pregnancy and history of cyclophosphamide treatment were only correlated with maternal complications. The area under the curve for SLEDAI score of adverse pregnancy outcome was 0.726 (95% CI 0.65-0.81) and cumulative steroid dose after SLE onset and median steroid dose during pregnancy for maternal outcome were 0.658 (95% confidence interval (CI) 0.55-0.76) and 0.750 (95% CI 0.65-0.85). The optimal cut-off value for SLEDAI was 4 and cumulative and median steroid dose were 2750mg and 6mg, respectively. Conclusion: Pregnant women with SLE have a higher risk of adverse pregnancy outcomes. Pregnancies should be delayed until disease activity is well controls (SLEDAI&lt;4) for longer than 6 months. References: [1]L-W Kwok, LS Tam, TY Zhu, et al., Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus. Lupus 2010;20:781-791 [2]E Sugawara, M Kato, Y Fugieda, et al., Pregnancy outcomes in women with rheumatic disease: a real-world observational study in Japan. Lupus 2019;28:1407-1416 [3]M Clowse, M Jamison, E Myers, et al., A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 2008;199:127.e1-127.e6 Disclosure of Interests: None declared