OUTCOME OF PREGNANCY IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN EMAM KHOMEINI HOSPITAL - URMIA.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects primarily women, commonly in their reproductive years. Clinicians have to face the many problems of pregnancy in patients with SLE including the influence of SLE on fetal outcome and that of pregnancy on SLE. This study was performed to study maternal and fetal outcomes in women with SLE.

Material and Methods: It is a retrospective study of 20 pregnancies in 13 women with SLE in nephrology department in Urmia University of Medical sciences.

Results: The mean age of patients was 24 years old (ranges between 19–37). Seven patients were nulliparous. 15 of 20 pregnancies occurred in remission phase and others in active phase. In 5 patients kidney biopsy was performed before pregnancy. There was one patients on stage 2, three on stage 3 and one on stage 4 of lupus nephritis before pregnancy. The kidney function in all patients was normal before pregnancy. 2 of 13 patients had positive antiphospholipid antibodies (APA) but only one of them had past history of multiple abortion and deep vein thrombosis in lower exterimities. In all of APA positive patients aspirin and heparin were used. In 7 cases non-nephrotic range proteinuria was seen during pregnancy but no impairment of renal function, no hypertension and no maternal mortality was seen. In 3 cases flare up of SLE occurred during pregnancy with no influence on fetal and maternal outcome. The median gestational age was 37 weeks (range between 34 -39 weeks) with 5 preterm deliveries. Two Intrauterine Fetal Death (IUFD) and one abortion occurred. Mean birth weight was 2160 grams.The median Apgar score was 8 at birth.There was one IUGR and 3 Low Birth Weight (LBW). Only one LBW infant was from mother with active disease before pregnancy. Only one of 5 pregnancies in APA positive mothers was failed. Except one, all cases were on steroid treatment at time of conception.

Conclusion: The probabilities of favorable fetal and maternal outcomes is high in women with stable and prolonged remission of SLE, normal renal function, normal blood pressure and negative APA. However, the risk of fetal loss and/or kidney function deterioration is high in patients with active SLE and/or renal insufficiency. Pregnancy planning during the inactive phase of renal disease, careful monitoring of blood pressure and renal function and treatment with Heparin and low dose aspirin in women with positive APA are the prerequisite for successful pregnancies in SLE.