Improved Outcomes In High Risk Lupus Pregnancies: Usefulness Of a Protocol Based Multidisciplinary Approach In Kerala, India

Vinod Ravindran¹, S Bhadran², P Shyjus³, M Divakaran⁴ and V Reshma⁵, ¹Department of Rheumatology, MES Medical College, Kerala, INDIA, Perinthalmanna, India, ²Department of Obstetrics, National Hospital, Calicut, India, ³Department of Obstetrics, MES Medical College, Perinthalmanna, India, ⁴Department of Obstetrics, PVS Hospital, Calicut, India, ⁵Department of Obstetrics, Indira Gandhi Hospital, Thalassery, India

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Lupus, SLE and pregnancy

Session Information

Title: Systemic Lupus Erythematosus-Clinical Aspects III: Biomarkers, Quality of Life and Disease Indicators, Late Complications

Session Type: Abstract Submissions (ACR)

Background/Purpose: In patients with SLE who had previous adverse obstetric outcome(s) the risk of an adverse outcome in subsequent pregnancy rises. The primary objective of this study was to assess the impact of a protocol based multidisciplinary care on pregnancy outcome(s) in a prospective cohort of patients with SLE who had previous adverse obstetric outcome(s).

Methods: Between March 2010 and March 2013 all patients with SLE fulfilling the ACR classification criteria with previous at least one adverse obstetric outcome (maternal; preterm labour, pre ecalampsia or previous medical termination of pregnancy (MTP) in view of SLE flare, foetal; miscarriage, IUGR, preterm birth, low birth weight (LBW), intrauterine death or still birth) desirous of having more children were prospectively enrolled. All patients had in-depth preconception counselling and were prospectively followed throughout the pregnancy as per the protocol with multidisciplinary team input. Therapeutic changes were made as necessary at each visit.

Results: Twenty-one patients (age mean±SD years; 28±3) were enrolled. Previous poor obstetric outcomes were: miscarriage(s) in 8, MTP in 7, preterm labour with IUGR in 3, intrauterine death, still birth and pre ecalapmsia in 1 each. Five patients had secondary APS and 8 had both or either Ro/La positive. Three had lupus nephritis (LN); >6months ago in 2. There were 15 (75%) live births (3 LBW; instrumentation or caesarean section in 5). Three patients had miscarriages (one had ongoing LN). One decided against becoming pregnant after the initial counselling. Seven patients (35%) had lupus flare (4 mild, 2 moderate and 1 severe based on SLEDAI).

Conclusion: Majority of patients in our prospective cohort had acceptable pregnancy outcome. This highlights that for high risk lupus pregnancies a multidisciplinary input with protocol based care offers a superior chance of improved pregnancy outcome.

Disclosure:

V. Ravindran,
None;

S. Bhadran,
None;

P. Shyjus,
None;

M. Divakaran,
None;

V. Reshma,
None.

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