Background/Purpose: Pregnancies in women with systemic lupus erythematosus (SLE) are associated with increased frequencies of adverse pregnancy outcomes (APOs). Preconception counseling including risk stratification and adjustment of medication is strongly recommended by EULAR¹. However, a considerable number of women with SLE do not seek such advice before conception. Our aim was to assess the impact of pregnancy counseling prior to conception on the outcome of pregnancies in women with SLE referred to our lupus pregnancy clinic (2000-2015).

Methods: All pregnancies in women with SLE who received an individual pregnancy counseling prior to conception were prospectively followed during pregnancy and postpartum period according to a standard protocol (group A). Outcome of these pregnancies was compared to pregnancies in women with SLE who were already pregnant by the time of their first appointment in our clinic (group B). APOs were defined as fetal loss (spontaneous abortion or stillbirth), severe pregnancy disorders (preeclampsia, HELLP-syndrome), birth before 36 weeks (due to placental insufficiency, hypertension, or preeclampsia) and low birth weight (< 2500 g). Systemic Lupus Erythematosus Pregnancy Disease Activity Index (SLEPDAI) was used to gauge disease activity during pregnancy.

Results: A total of 188 pregnancies in 151 women with SLE (median age 31 years) were included (group A = 137; group B = 51). 67 % of all women had been pregnant before, 33 % had experienced at least one fetal loss and 9 % severe pregnancy disorders. With respect to all pregnancies, a live birth was documented in 172 (91.5 %) [group A 94.2% vs group B 86.3 %)]. A fetal loss occurred in 16 (8.5 %) pregnancies [group A 5.8 % vs. group B 15.7 %). Twenty-three (12.2%) of all pregnancies were complicated by severe pregnancy disorders (group A 5.8 % vs group B 29.4 %) and 28 (14.9 %) by preterm birth (group A 7.3 %; group B 35.3 %). One newborn (group B) died shortly after extreme preterm birth. After adjusting for maternal age and for higher disease activity in the first trimester (SLEPDAI ≥ 4) we observed significantly higher rates of fetal losses (RR = 3.4; 95%CI 1.4-8.6), severe pregnancy disorders (RR = 5.5; 95%CI 2.5 – 12.1), preterm birth (RR = 5.6; 95%CI 2.8 – 11.2) and low birth weight (RR = 3.2; 95%CI 1.9 – 5.4) in group B compared to group A.

Conclusion: The main prognostic risk factor for adverse outcomes in our observational cohort of 188 SLE-pregnancies was the lack of preconception counseling. These patients had significant higher risks of fetal loss, preterm birth, low birth weight and severe pregnancy disorders. Though our observed live birth rate was considerable high in both groups, probably due to an adapted multidisciplinary management during the course of pregnancy, consultation before conception was still associated with higher live birth rates (94,2 vs. 86,3%). Women with SLE and pregnancy wish should be informed about the obvious beneficial effect of preconception counseling. ¹Andreoli L. “EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy, and menopause in patients with Systemic Lupus Erythematosus and/or the Antiphospholipid Syndrome.” (in press)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-pregnancy-counseling-on-the-outcome-of-pregnancies-in-women-with-systemic-lupus-erythematosus-a-prospective-observational-study/