Patients With LN Require Careful Monitoring During Pregnancy

Among women with systemic lupus erythematosus (SLE), those diagnosed with lupus nephritis (LN) experienced more complications of pregnancy but did not experience worse outcomes, according to a new study.

Investigators in Argentina conducted a retrospective study of a total of 121 among 79 patients with SLE who were seen at the Materno Neonatal Hospital in Cordoba, Argentina from January 2015 to April 2017. Of these pregnancies, 69 were among patients with LN. The researchers collected clinical, laboratory, and demographic data on these patients and evaluated antiphospholipid syndrome (APS), antiphospholipid antibodies (AAF), and maternal and fetal outcomes.

Patients with LN more frequently evidenced APS and AAF and had higher scores on the SLE Disease Activity Index (SLEDAI). These patients also received higher doses of steroids and more immunosuppressive therapy than the SLE patients without LN.  The pregnant patients with LN also had more frequent lupus flares—25.8% vs 10.9% among patients without LN (P=.041). These disease flares were primarily renal. No patients developed end-stage renal failure.

Preeclampsia occurred in 18.8% of the patients with LN vs 6.3% in the group without LN (P=.047). More patients with LN required a cesarean section (68.5%) than among patients with SLE but without LN (31.5%).

The investigators found no difference in fetal outcomes of live birth, gestational age, birth weight, fetal distress, or perinatal death between the two groups. There was one maternal death.

“Patients with LN experienced more maternal complications such as lupus flares and preeclampsia,” the authors concluded. “However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.”

--Rebecca Mashaw

Otaduy C,  Gobbi CA, Álvarez A, Albiero EH, Yorio MA, Alba Moreyra P. Is lupus nephritis a prognosis factor for pregnancy? Maternal and foetal outcomes. Reumatol Clin. Published online April 21, 2021. DOI: 10.1016/j.reuma.2021.02.011