Chiara Tani1, Dina Zucchi1, Isabell Haase2, Maddalena Larosa3, Francesca Crisafulli4, Francesca A L Strigini5, Francesca Monacci5, Elena Elefante1, Johanna Mucke2, May Y Choi6, Laura Andreoli4, Luca Iaccarino3, Angela Tincani4, Andrea Doria3, Rebecca Fischer-Betz2, Marta Mosca1. 1. Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 2. Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany. 3. Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova. 4. Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, University of Brescia, Brescia. 5. Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 6. Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Abstract
OBJECTIVES: To determine whether disease remission or low disease activity state at the beginning of pregnancy in SLE patients is associated with better pregnancy outcome. METHODS: Pregnancies in SLE patients prospectively monitored by pregnancy clinics at four rheumatology centres were enrolled. Patient demographics and clinical information were collected at baseline (pregnancy visit before 8 weeks of gestation) including whether patients were in remission according to the Definition of Remission in SLE (DORIS) criteria and and/or Lupus Low Disease Activity State (LLDAS). Univariate and multivariate analysis were performed to determine predictors of disease flare and adverse pregnancy outcomes (APOs) including preeclampsia, preterm delivery, small for gestational age infant, intrauterine growth restriction and intrauterine fetal death. RESULTS: A total of 347 pregnancies were observed in 281 SLE patients. Excluding early pregnancy losses, 212 pregnancies (69.7%) occurred in patients who were in remission at baseline, 33 (10.9%) in patients in LLDAS, and the remainder in active patients. Seventy-three flares (24%) were observed during pregnancy or puerperium, and 105 (34.5%) APOs occurred. Multivariate analysis revealed that patients in disease remission or taking HCQ were less likely to have disease flare, while a history of LN increased the risk. The risk of APOs was increased in patients with shorter disease duration, while being on HCQ resulted a protective variable. An almost significant association between complete remission and a decreased risk of APOs was observed. CONCLUSIONS: Prenatal planning with a firm treat-to-target goal of disease remission is an important strategy to reduce the risk of disease flares and severe obstetric complications in SLE pregnancies.
OBJECTIVES: To determine whether disease remission or low disease activity state at the beginning of pregnancy in SLE patients is associated with better pregnancy outcome. METHODS: Pregnancies in SLE patients prospectively monitored by pregnancy clinics at four rheumatology centres were enrolled. Patient demographics and clinical information were collected at baseline (pregnancy visit before 8 weeks of gestation) including whether patients were in remission according to the Definition of Remission in SLE (DORIS) criteria and and/or Lupus Low Disease Activity State (LLDAS). Univariate and multivariate analysis were performed to determine predictors of disease flare and adverse pregnancy outcomes (APOs) including preeclampsia, preterm delivery, small for gestational age infant, intrauterine growth restriction and intrauterine fetal death. RESULTS: A total of 347 pregnancies were observed in 281 SLE patients. Excluding early pregnancy losses, 212 pregnancies (69.7%) occurred in patients who were in remission at baseline, 33 (10.9%) in patients in LLDAS, and the remainder in active patients. Seventy-three flares (24%) were observed during pregnancy or puerperium, and 105 (34.5%) APOs occurred. Multivariate analysis revealed that patients in disease remission or taking HCQ were less likely to have disease flare, while a history of LN increased the risk. The risk of APOs was increased in patients with shorter disease duration, while being on HCQ resulted a protective variable. An almost significant association between complete remission and a decreased risk of APOs was observed. CONCLUSIONS: Prenatal planning with a firm treat-to-target goal of disease remission is an important strategy to reduce the risk of disease flares and severe obstetric complications in SLE pregnancies.
Authors: Chiara Tani; Dina Zucchi; Isabell Haase; Maria Gerosa; Maddalena Larosa; Lorenzo Cavagna; Alessandra Bortoluzzi; Francesca Crisafulli; Johanna Mucke; Francesca A L Strigini; Laura Baglietto; Marco Fornili; Francesca Monacci; Elena Elefante; Roberta Erra; Elisa Bellis; Melissa Padovan; Laura Andreoli; Lavinia Agra Coletto; Giovanni Zanframundo; Marcello Govoni; Luca Iaccarino; Angela Tincani; Andrea Doria; Rebecca Fischer-Betz; Marta Mosca Journal: Lupus Sci Med Date: 2022-06
Authors: Merlijn Wind; Maike Hendriks; Marieke Sueters; Y K Onno Teng; Bernadette T J van Brussel; Jeroen Eikenboom; Cornelia F Allaart; Hildo J Lamb; Hans-Marc J Siebelink; Maarten K Ninaber; Nan van Geloven; Jan M M van Lith; Tom W J Huizinga; Ton J Rabelink Journal: Lupus Sci Med Date: 2021-05