ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2671

Impact of Glucocorticoid Dose on Maternal and Fetal Outcomes in Lupus Pregnancies

Dafhne Miranda1, Miguel A. Saavedra2, Eduardo Gomez3, Alberto Daniel Rocha Muñoz4, Jorge Gaspar Ramos5 and Luis Javier Jara6, 1Rheumatology, Rheumatology Unit, Hospital de Especialidades. Centro Médico La Raza, IMSS, Distrito federal, Mexico, 2Rheumatology, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico, 3Institute for Research in Rheumatology and Musculoskeletal System, Guadalajara, Mexico, 4Institute for Research in Rheumatology and Musculoskeletal System, Guadalajara, Jalisco, Mexico, 5Rheumatology Unit, Hospital de Especialidades. Centro Médico La Raza, IMSS, Distrito federal, Mexico, 6Direction of Education and Research in health, Instituto Mexicano del Seguro Social, D.F., Mexico

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment: Epidemiology, Women's Health, Cardiovascular and CNS

Session Type: Abstract Submissions (ACR)

Background/Purpose

  • Lupus flares during pregnancy can be treated with short courses of low to moderate doses of glucocorticoids (GCs). GCs are associated with several maternal and fetal complications during pregnancy, however information about the role of the dose in the development of these complications is limited
  • To analyze the role of GCs in the development of maternal and fetal complications in women with systemic lupus erythematosus (SLE) and if these complications are dose-related

 Methods

We prospectively studied a cohort of pregnant women with SLE (ACR 1997) between January 2009 and August 2013. The patients were assessed every 4 to 6 weeks and postpartum by a rheumatologist and a gynecologist. Clinical, biochemical and immunological characteristics of women, along with maternal and fetal complications, were recorded. For analysis, the patients were first assigned to one of two groups: pregnancies exposed to GCs vs those not exposed. Secondly, to evaluate the dose effect of GCs, we compared three dose ranges throughout pregnancy: prednisone £10 mg daily, prednisone >10-24 mg daily and prednisone ≥25 mg daily. Statistical analysis included descriptive statistics, chi square, Student t test, Fisher´s exact test, ANOVA and Scheffe´s test as post-hoc and logistic regression; relative risk (RR) with confidence intervals (CI) of 95% were calculated. For the analysis each pregnancy was considered as an independent event.

Results

  • We included 143 pregnancies in 136 patients. There were 111 pregnancies exposed to GCs and a greater exposure to azathioprine (55% vs 21.9%, p=0.001) in comparison with those not exposed to GCs. There were no differences in maternal complications in the analyzed groups by dose ranges. Major fetal complications were dose-related: low weight, low height, and preterm birth. In the multivariable analysis, the use of prednisone >25mg daily was associated with preterm birth (RR 3.3, CI 95% 1.39-8.04, p=0.0002), low birth weight (RR 3.25, CI 95% 1.37-7.18, p=0.0001).

Conclusion

  • This study suggests that fetal complications associated with the use of prednisone are dose-related (>25 mg). The use of low to moderate doses of prednisone during pregnancy is safety.

Disclosure:

D. Miranda,
None;

M. A. Saavedra,
None;

E. Gomez,
None;

A. D. Rocha Muñoz,
None;

J. G. Ramos,
None;

L. J. Jara,
None.

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