Obstetrical Outcome of Pregnancy in Patients with Systemic Lupus Erythematosus

Objective: To assess the impact of systemic lupus erythematous (SLE) on the outcome of pregnancy and the course of disease during pregnancy. Study Design: During a period of three years we prospectively followed thirty pregnancies in thirty SLE patients in a tertiary care centre, for each case two age and parity-matched healthy control (60) were chosen. The management protocol included: • Planning of conception when disease was inactive. • Frequent follow-up visits by an internist-obstetrician team. • Use of sequential ultrasonographic, Doppler and fetal echo cardiographic examination. • Serial evalution of maternal immunological condition. • The same dose of steroids or immunosuppressives as before pregnancy was continued. Results: In the study group the mean age of patients was 27.1+3.8 years and mean previous duration of SLE at booking was (4.2±2.5). SLE was active at conception in four cases (13.3%); at that time all patients were taking prednisolone. In control group the mean age of patients was 25.3±3.2 years. In the study group there were 23 live birth (88.6%) with 15 full term and 8 premature deliveries, 4 (13.3) spontaneous abortion, 3 (10%) intra uterine foetal death. In the cotrol group there were 54 live birth (98.1%) with 39 full term and 15 premature deliveries, 5 (8.3%) spontaneous abortion, one (1.0%) intra uterine foetal death. The mean gestational age of live births were 35.8 weeks and 37.5 weeks respectively p 0.05. The mean birth weight of live births were 2108gm and 2750gm respectively p 0.05. Flares up of disease activity occur in 4 of 26 pregnancies. Conclusion: We conclude from our study that pregnancy induce SLE flare-up is uncommon but SLE is associated with increased incidence of intrauterine growth retardation. All of our patients were on corticosteroid therapy during pregnancy and it is possible that steroid therapy may have contributed to the low flare-up rate.