OBJECTIVE: The importance of low complement and anti-dsDNA during pregnancy in patients with systemic lupus erythematosus (SLE) is poorly defined. We investigated the effect of these laboratory tests and clinical SLE activity on pregnancy outcomes. METHODS: We conducted a study of all pregnancies in patients with SLE followed from 1986 to 2002 in a cohort of patients with SLE. At each visit, the physician's estimate of activity (PEA), complement, and anti-dsDNA antibody were measured. We assessed the combination of moderate to severe SLE clinical activity (defined as PEA ≥ 2) and these serologic measurements on pregnancy outcomes. Pregnancies electively terminated were excluded from our study. RESULTS: Regardless of SLE activity, low complement or positive anti-dsDNA in the second trimester was associated with a higher rate of pregnancy loss and preterm birth. Patients with the combination of either high clinical activity of SLE and low complement or positive anti-dsDNA had the highest rate of pregnancy loss and preterm birth. CONCLUSION: Women with the combination of high clinical activity with serologic markers of SLE activity are at highest risk for pregnancy loss and preterm delivery. While hypocomplementemia and positive anti-dsDNA alone are predictive of poor pregnancy outcomes in the second trimester, the risks are far higher for the women in whom this is coupled with clinically active SLE.
OBJECTIVE: The importance of low complement and anti-dsDNA during pregnancy in patients with systemic lupus erythematosus (SLE) is poorly defined. We investigated the effect of these laboratory tests and clinical SLE activity on pregnancy outcomes. METHODS: We conducted a study of all pregnancies in patients with SLE followed from 1986 to 2002 in a cohort of patients with SLE. At each visit, the physician's estimate of activity (PEA), complement, and anti-dsDNA antibody were measured. We assessed the combination of moderate to severe SLE clinical activity (defined as PEA ≥ 2) and these serologic measurements on pregnancy outcomes. Pregnancies electively terminated were excluded from our study. RESULTS: Regardless of SLE activity, low complement or positive anti-dsDNA in the second trimester was associated with a higher rate of pregnancy loss and preterm birth. Patients with the combination of either high clinical activity of SLE and low complement or positive anti-dsDNA had the highest rate of pregnancy loss and preterm birth. CONCLUSION:Women with the combination of high clinical activity with serologic markers of SLE activity are at highest risk for pregnancy loss and preterm delivery. While hypocomplementemia and positive anti-dsDNA alone are predictive of poor pregnancy outcomes in the second trimester, the risks are far higher for the women in whom this is coupled with clinically active SLE.
Authors: Luis J Jara; Gabriela Medina; Pilar Cruz-Dominguez; Carmen Navarro; Olga Vera-Lastra; Miguel A Saavedra Journal: Immunol Res Date: 2014-12 Impact factor: 2.829
Authors: Jill P Buyon; Mimi Y Kim; Marta M Guerra; Sifan Lu; Emily Reeves; Michelle Petri; Carl A Laskin; Michael D Lockshin; Lisa R Sammaritano; D Ware Branch; T Flint Porter; Allen Sawitzke; Joan T Merrill; Mary D Stephenson; Elisabeth Cohn; Jane E Salmon Journal: Clin J Am Soc Nephrol Date: 2017-04-11 Impact factor: 8.237
Authors: Jill P Buyon; Mimi Y Kim; Marta M Guerra; Carl A Laskin; Michelle Petri; Michael D Lockshin; Lisa Sammaritano; D Ware Branch; T Flint Porter; Allen Sawitzke; Joan T Merrill; Mary D Stephenson; Elisabeth Cohn; Lamya Garabet; Jane E Salmon Journal: Ann Intern Med Date: 2015-08-04 Impact factor: 25.391