Background/Purpose: To investigate the outcomes of pregnancy and neonatal and the risk factors of lupus flares and pregnancy complications in Chinese patients with lupus nephritis (LN).

Methods: One hundred female patients with LN after complete remission prior to the conception (remission group) were prospectively followed from Jan 2010 to Dec 2016. Twenty-seven LN patients without complete remission prior to conception and unplanned pregnancies were collected concurrently as the control group. Glucocorticoids(GS) or GS plus other applicable immunosuppressant were given during the pregnancy. The rate and risk factors of LN relapse, maternal and neonatal complications, including preeclampsia, abortion, fetal death, intrauterine growth restriction (IUGR) and preterm delivery were analyzed.

Results: In the remission group, 100 LN patients had 104 times of pregnancies and delivered 96 healthy children. During pregnancy, immunosuppressive regimens were GS alone in 74 pregnancies, GS plus other immunosuppressant in 23 pregnancies, no drug in 7 pregnancies. LN relapse developed in 15 (14.42%) pregnancies, logistic regression analysis showed that the duration of complete remission less than 12 months (OR:200.324 (95% CI 197.967-202.681), P=0.025) and positive anti-C1q antibody (OR:58.159 (95%CI 56.229-60.089), P=0.035) before pregnancy were the two independent risk factors for the relapse. Thirty-seven pregnancies (35.85%) developed pregnancy and neonatal complications, including 19 preterm delivery, 5 preeclampsia, 5 IUGR and 8 fetal loss (7 spontaneous abortion,1 elective abortion due to preeclampsia). Complete remission time less than 6 months before pregnancy (OR：19.481(95%CI 18.003-20.959),P=0.045) was associated with preterm delivery, while hypocomplementemia(OR:11.287(95%CI 10.06-12.514),P=0.048) and positive antiphospholipid antibody(OR:7.118(95%CI 6.193-8.043)，P=0.034) before pregnancy were associated with the fetal loss. In the control group, the rate of lupus relapse (21/27,77.78%) and pregnancy and neonatal complications (23/27, 85.19%) were significantly higher than that in the remission group (p< 0.01).

Conclusion: Complete remission prior to pregnancy and maintaining immunosuppressive treatment during pregnancy showed good pregnancy and neonatal outcomes in patients with lupus nephritis. The duration of complete remission, serum levels of anti-C1q antibody and complement and antiphospholipid antibody were associated with the relapse and pregnant associated complications.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/good-pregnancy-and-neonatal-outcomes-in-lupus-nephritis-patients-with-complete-remission/