Background/Purpose: Preeclampsia complicates up to 35% of lupus pregnancies compared to 8% of general population pregnancies. SLE has up to a 3-fold increased rate of preeclampsia. The aim of this cohort study was to determine whether variables measured in the first trimester could help predict which women will develop pre-eclampsia.

Methods:  Only pregnancies with a clinic visit during the first trimester were included.  All women were diagnosed with SLE either before or during the pregnancy, according to the American College of Rheumatology (ACR) revised classification criteria.  Preeclampsia was defined according to the American College of Gynecology (ACOG), as follows: systolic blood pressure of 140 mm Hg or higher or diastolic of 90 mm Hg or higher in patients with previously normal blood pressure, taken on two occasions, measured after 20 weeks of gestation; and proteinuria, defined as urinary protein excretion of more than 0.3 g in a 24-hour urine collection.  Rates of pre-eclampsia were calculated in subgroups defined by variables measured in the first trimester, defined as the first 13 weeks of pregnancy. 

Results: A total of 280 pregnancies from 234 different women were included in this analysis. The patients were 62% Caucasian, 28% African American, and 10% other ethnicities.  Twenty-nine (10%) of the pregnancies met the definition of preeclampsia. Table 1 shows the rates of pre-eclampsia by patient subgroups. There was not strong evidence of an association between lupus-related variables such as anti-dsDNA, low complement, global disease activity and risk of pre-eclampsia.  Also, there was no strong evidence of a relationship between medications such as prednisone, hydroxychloroquine and risk of pre-eclampsia.

Conclusion: Preeclampsia development in SLE patients cannot be predicted in the first trimester.  Disease activity, serologic activity, proteinuria, antiphospholipid antibodies and prednisone are not predictive. 

 

Table 1:  Number (%) with Preeclampsia Assessed in The First Trimester.

Pregnancy Characteristic	Number of Pregnancies1	Number (%) with pre-eclampsia	P-value
Systolic Blood Pressure     <120     120-129     130-139     140+	152 65 28 21	12 (8%) 9 (14%) 3 (11%) 3 (20%)	0.56
Diastolic Blood Pressure     <70     70-79     80+	112 90 64	10 (9%) 6 (7%) 11 (17%)	0.15
Taking Hypertension Medication     No     Yes	241 33	21 (9%) 7 (21%)	0.097
BMI     <20     20-25     25-30     30+	25 109 61 47	1 (4%) 12 (11%) 6 (10%) 8 (17%)	0.48
SLEDAI     0     1-3     4+	105 65 103	10 (10%) 8 (12%) 10 (10%)	0.84
PGA     0-0.499     0.5-1.0     >1.0	196 42 42	23 (12%) 4 (10%) 2 (5%)	0.25
Log DNA titer     0     <5     5+	179 48 38	18 (10%) 5 (10%) 5 (13%)	0.87
Low C3     No     Yes	182 86	19 (10%) 9 (10%)	0.99
Low C4     No     Yes	188 80	21 (11%) 7 (9%)	0.55
RVVT     <45     45+	165 16	21 (13%) 2 (13%)	0.98
Anti-cardiolipin     Not elevated    > 10 for at least one isotype	58 47	7 (12%) 4 (9%)	0.54
Urine Protein Dip Stick     0     0.5     1     2+	194 29 20 22	19 (10%) 1 (3%) 5 (25%) 1 (5%)	0.13
Prednisone     None     1-9 mg/d    10-19 mg/d     20+ mg/d	132 63 47 30	15 (11%) 5 (8%) 4 (9%) 4 (13%)	0.80
Plaquenil     No     Yes	146 127	17 (12%) 11 (9%)	0.40
Serum Creatinine     <0.7     0.7-0.99     1.0+	98 134 36	8 (8%) 17 (13%) 3 (8%)	0.48

¹ Numbers of pregnancies do not always add up to 280 due to missing values for predictors.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/first-trimester-disease-activity-does-not-predict-pre-eclampsia-in-sle-pregnancy/