AB0986 LUPUS NEPHRITIS AND RISK OF PREECLAMPSIA IN HISPANIC/LATIN PREGNANT PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS
Authors: J. Cajamarca-Baron, J. P. Castañeda-Gonzalez, E. Bedoya, C. Sanmiguel-Reyes, S. Molina-Giraldo, C. Ibañez, P. Snelle, K. Langhorst, A. Rojas-Villarraga
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Worldwide, women are more likely than men to develop systemic lupus erythematosus (SLE), with an incidence of 8.82 per 100,000 person-years. Hispanic/Latin (H/L) women develop SLE at an earlier age than Caucasians women, with a higher prevalence of pregnant H/L women with SLE. Most diagnoses occur during the childbearing years. Disease activity increases the risk of pregnancy loss associated with pregnancy-induced hormonal and immunologic changes. Women with SLE are at increased risk for pregnancy complications such as pre-eclampsia, stillbirth, and preterm delivery. Hypertensive disorders in pregnancy are more common in pregnancies with SLE in H/L women (28.6%) compared to the general population in Latin America and the Caribbean (1.8-7.7%). Unfortunately, there are few studies in the H/L population with SLE and pregnancy that allow us to know the impact and course of the disease in comparison to other populations. <h3>Objectives:</h3> The aim of this study is to perform a systematic review and meta-analysis of the evidence of the association between lupus nephritis (LN) and the development of pre-eclampsia in pregnant women with SLE in Latin America. <h3>Methods:</h3> This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The protocol was submitted to PROSPERO, the International Prospective Register of Systematic Reviews, under the number CRD-42023439168. The search focused on SLE and pregnancy in Latin America, using databases such as PubMed, LILACS, SciELO, and the Virtual Health Library (BVS). Articles published until December 2022 were included using a comprehensive search strategy that included MeSH terms for Latin American countries and SLE/pregnancy. The PubMed search included countries individually combined with the MeSH terms "systemic lupus erythematosus" and "pregnancy". No language, time period, or publication type restrictions were imposed. DeCS translated MeSH terms for the SciELO, LILACS, and BVS searches. Two independent reviewers conducted the search and resolved disagreements by consensus using the Rayyan tool. This review included cohorts and case-control studies that met validated criteria for SLE and data availability. Studies containing minors and studies lacking individual patient characteristics were excluded. Three reviewers organized selected articles by source, author, treatment, disease, and obstetric outcomes. Data were abstracted into a homogeneous database using the REDCap application. Disagreements among reviewers were resolved by consensus. Meta-analyses using relative risk (RR) and a random effects model were performed to assess LN and pre-eclampsia. The Mantel-Haenszel method (RevMan 5.4.1) was used to calculate the overall effect estimate with a 95% confidence interval. <h3>Results:</h3> 44 articles were included, 12 of which were dependent on other cohorts. There were 3998 patients with an average age of 28 years. Of these, 1776 were pregnant women with SLE, contributing to the analysis of 2190 pregnancies related to SLE. Of the 44 articles, 18 focused on outcomes related to LN during pregnancy. 8 articles focused on pre-eclampsia, prompting a meta-analysis for deeper insights. The pooled data showed that pregnant women with LN had an increased risk of pre-eclampsia (RR=1.89; 95% CI 1.40-2.55) compared with those without LN (Figure 1). Sensitivity analyses consistently supported these findings. The Higgins I2 statistic indicated low heterogeneity (10%), a finding confirmed by the heterogeneity test (chi2 - P value=0.36), which reported homogeneity between studies and their different populations. A visual examination of the funnel plot (scatterplot) showed a symmetric distribution of articles, suggesting a possible low publication bias due to the limited number of articles. <h3>Conclusion:</h3> Pregnant H/L SLE women with LN have a higher risk of pre-eclampsia compared to H/L SLE women without LN. Therefore, it is crucial to provide comprehensive preconception counseling to women with SLE. In case of pregnancy, strict monitoring plans should be established to detect LN early and promote maternal-fetal well-being. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>