Background/Purpose: Active SLE, in particular lupus nephritis, during the six months prior to conception is associated with disease flare during pregnancy. Previous studies, however, have not evaluated how other disease manifestations prior to conception are related to disease activity during pregnancy. We sought to investigate the relationship between SLE organ-specific disease activity in the six months prior to conception and organ-specific disease activity during pregnancy.

Methods: We identified SLE patients with >2 visits to our Lupus Center and ≥1 pregnancy lasting >12 weeks from 1990-2013, who had clinical and lab data available for the six months prior to conception and during pregnancy. All women had confirmed SLE by rheumatologist review for 1997 ACR Criteria for Classification. We collected data on: age, pregnancy outcomes, SLE medication use, history of nephritis, serositis (pleuritis, pericarditis), inflammatory arthritis, skin disease (malar rash, discoid lesions, photosensitivity), antiphospholipid antibody syndrome, hematologic disorder (leukopenia, hemolytic anemia, thrombocytopenia), anti-dsDNA elevation, and low complement, both in the six months preceding and during pregnancy. We analyzed the data using Fisher’s exact tests.

Results: Among 1,127 women with SLE, 149 pregnancies occurred in 115 women. Mean age at SLE diagnosis was 23.8 (SD 6.8) years and at conception was 31.1 (SD 5.2) years; average SLE duration prior to pregnancy was 7.8 (SD 5.8) years; 8.7% were diagnosed with SLE during pregnancy. 68.7% were White, 14.8% Hispanic, 9.6% Black, and 7.0% Asian. During pregnancy the most common SLE manifestations were hematologic (15.4%), nephritis (10%), skin (9.4%), arthritis (6.7%), and serositis (4.7%). Activity of each of these SLE manifestations in the six months prior to conception was significantly associated with occurrence of the same manifestation during pregnancy. In contrast, patients without these clinical findings in the six months prior to pregnancy were unlikely to have activity in these organ systems during pregnancy. (Table 1)

Conclusion: Among women with SLE who had any organ system disease activity six months prior to conception, a large proportion had persistent symptoms of the same type during pregnancy. Those patients with quiescent organ-system manifestations six months prior to pregnancy were unlikely to become symptomatic during pregnancy. To our knowledge, this is the first study to reveal that organ-specific SLE manifestations, in addition to nephritis, in the six months prior to conception portend similar disease manifestations during pregnancy.

Table 1. Organ-specific SLE disease activity six months prior to conception and during pregnancy, N=149 pregnancies

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