AB1140 PREGNANCY IN SYSTEMIC LUPUS ERYTHEMATOSUS: ABOUT 137 PREGNANCIES
Authors: W. Ammouri, F. Ibourk el Idrissi, A. Taouch, S. Belkhettab, N. Mouatassim, H. Khibri, M. Maamar, H. Harmouche, Z. Tazi Mezalek, M. Adnaoui
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Pregnancy is associated with a risk of serious complications in patients systemic lupus erythematosus (SLE). These complications may worsen the obstetrical and maternal prognosis and justify pregnancy planning with appropriate management. <h3>Objectives:</h3> The aim of this work is to reporting the modes of clinical and biological presentations of pregnancies associated with LES on a mono-centric, Moroccan cohort and analyze their prognosis. <h3>Methods:</h3> This is a descriptive and observational retrospective study of 137 pregnancies in 52 women followed up or hospitalized for treatment of lupus Systemic erythematosis at the Internal Medicine Department of CHU IBN SINA, Rabat between 1999 and December 2022. The diagnosis of SLE was selected according to the criteria of EULAR/ACR 2019 classification. <h3>Results:</h3> A total of 52 patients had 137 pregnancies. Their average age at the time of diagnosis was 25. 7 years (14-40 years). 17 patients were receiving contraception 5 patients were on mechanical contraception. skin involvement was found in 43 patients (82. 7%), joint involvement in 50 patients (96. 2%), renal impairment in 26 patients (50%) proved histologically and was dominated by class IV lupus nephropathy and was complicated in 5 patients with chronic renal failure. 30 patients (57%) had a haematological involvement including 7 cases of autoimmune haemolytic anaemia and 10 case thrombocytopenia. 8 cases (15. 4%) of seritis were diagnosed and the neurological involvement was found in 14 patients (27%). The mean age of our patients at the time of pregnancy was 27. 2 years (19-43 years). 33 pregnancies (24%) were normal before the diagnosis of SLE. 23/137 cases (16%), pregnancy revealed lupus. All pregnancies were spontaneous, of which 60/137 (43.8%) were planned. 12 patients were in relapse at the time of conception. In 10/137 pregnancies (13. 7%) patients experienced a relapse during pregnancy. pregnancy: joint relapse (n=6), renal relapse (n=4), psychosis (n=1), haematological flare-up (n=1). And after 35/137 pregnancies (25. 54%) had a relapse after childbirth. 10 patients in our series had anti-SSA antibodies and 6 had anti-SSB, a syndrome of anti- phospholipids was found in 14 patients in our series. During 58 pregnancies (42. 34%) patients were on synthetic antimalarials (PSAs), during 44Pregnancies (32. 12%) patients were on corticosteroid therapy, during 7 pregnancies (5. 1%) were on Azathioprine,3 pregnancies(2. 19%) were Mycophenolate mofetil and a cyclophosphamide discontinued and replaced by azathioprine. Two patients (2. 74%) were receiving IVG monthly until delivery in the presence of a haematological flare-up thrombocytopenia. During 37 Pregnancies the patients received no treatment. Patients with APS were receiving preventive treatment byLow Molecular Weight Heparin (LMWH) combined with an antiplatelet agent. 90 live births were achieved (65.7%) following 82 term deliveries (59.85%) and 8 premature deliveries (5.87%), feotal losses were recorded in 47 cases (34.3%): 23 cases (16.79%) of miscarriage, 13 cases (9.49%) of feotal death in utero, of which 2 related to fetal AVB and one to pre-eclampsia, and 10 unexplained cases. Indication for medical termination of pregnancy was carried in 2 (1. 45%) cases before a complicated renal attack of renal failure. Delivery was vaginal in 59 cases (80.83%) and by Caesarean section in 17 cases (23.3%), with birth weights ranging from 1000 Kg to 3200 Kg with an average of 2285Kg among births neonatal death (n=5) (3. 6%) two due to malformative syndrome and 3 per congenital AVB, IUCN (n=17) (23. 3%). In patients with antibodies anti-SSA and/or anti-SSB positive one case of neonatal mortality has been reported following 1 AVB, 4 cases of prematurity and 3 cases of IUCN. One death from eclampsia was noted in one case, maternal complications were dominated by 8 cases of preeclampsia (5. 5%), including 2 cases of hellp syndrome and 9 cases (6%) of childbirth premature. <h3>Conclusion:</h3> Pregnancy in a woman with lupus is a high-risk situation and therefore requires special monitoring. The disease must be controlled before conception. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>