Background/Purpose:

The aim of this study is to determine the frequencies of abnormal pregnancy outcomes in a cohort of patients in Qatar and to identify clinical and laboratory factors predicting adverse fetal and maternal outcomes with systemic lupus erythematosus (SLE) in multinational population in Qatar.

Methods:

 Data of 69 pregnancies of 36 SLE patients from January 2005 to July 2012 in Hamad General Hospital in Qatar were analyzed retrospectively. Associations between qualitative variables were assessed using Chi-square or Fisher exact tests. Quantitative variables means between the two groups were analyzed using unpaired t test. Lupus activity was assessed based on SLE Disease Activity Index (SLEDAI) criteria.

Results:

Among 69 pregnancies (36 patients) 35 (50.7%) in Qatari and 34 (49.3%) were in non-Qatari national. Average numbers of pregnancies prior to and after onset of SLE were 3.73±1.8 and 2.72±1.5. Age at conception (years) and gestational age at delivery (weeks) were 34.5±5.4 and 37.4±2.8 respectively. Antiphospholipid (aPLs), Anti-Ro and Anti-La antibodies were present in 18 (26.1%), 23 (33.3%), 13 (18.8%) pregnancies respectively. There were 10 (14.5%) abortions, 5 (5.7%) stillbirths, 1 neonatal death and 54 (78.3%) live births including two twin gestations. Though, not statistically significant, baby weight at birth was found to be low (2.68±0.64 vs. 2.87±0.60, p=0.360) in active lupus patients compared to patients on remission. Pregnancy induced hypertension (PIH) (17.4% vs. 11.1%), intrauterine growth retardation (IUGR) (36.4% vs. 11.8%), preterm delivery (31.6 % vs. 11.8%), still birth (13% vs. 5.6%) and eclampsia (13% vs. 0%)were observed to be higher in active lupus patients compared to patients on remission. Compared with pregnancies without lupus nephritis (n=44), pregnancies with lupus nephritis (n=7) were associated with a higher risk of still birth (28.6% vs. 4.5%, p=0.092), higher rate of eclampsia (28.6% vs. 4.9%, p=0.103), IUGR (42.9% vs. 26.2%, p=0.626), and PIH (28.6% vs. 9.8%, p=0.412). The percentage of live births were higher in pregnancies without lupus nephritis compared to with lupus nephritis (42/44, 95.5% vs. 5/7, 71.4%, p=0.092), and live births were significantly higher in pregnancies without eclampsia compared to pregnancies with eclampsia (42/42, 100% vs. 2/7, 28.6%, p<0.001). Stillbirth and preterm delivery were found to be higher in pregnancies with proteinuria and presence of Anti-Ro antibody was significantly associated with IUGR (8/18, 44.4% vs. 6/37, 16.2%, p=0.034). One case of neonatal heart block was found in which Anti Ro/La antibody was positive. Low level of C3 was associated with higher rate of stillbirth, IUGR, preterm delivery, and PIH, however, the difference were not statistically significant (p>0.05).

Conclusion:

SLE in pregnancies in Qatar population were associated with higher risk adverse pregnancy outcomes. Disease activity during pregnancy, proteinuria, lupus nephritis and eclampsia/preeclampsia were all negatively associated with pregnancy outcome such as IUGR, still births and preterm delivery. Anti-Ro/La antibodies and low level of C3 were also associated with adverse pregnancy outcomes.

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« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-outcome-in-69-pregnancies-of-multinational-population-in-qatar-with-systemic-lupus-erythematosus/