Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach.

Our prospective study attempted to better define the reciprocal relation between pregnancy and systemic lupus erythematosus (SLE), to reduce maternal morbidity/mortality, and fetal loss. Our protocol included all the pregnancies in our total of patients with SLE between the years 1974-1983. There were 102 pregnancies in 75 patients during this period; SLE was exacerbated in 59.7% that started with inactive disease, most with mild episodes. Hematologic manifestations and renal disease, however, required moderate or high doses of steroids. There were no maternal deaths. There were 49% premature newborns in the entire group and this increased to 59% in mothers with active SLE; 23% of newborns were small for gestational age in the entire group and the rate increased to 65% in mothers with active SLE. There was a 16% spontaneous abortion rate with no difference between mothers with active or inactive disease, 5 stillbirths and one neonatal death, with a total fetal loss of 22% (compared with 6.7% in the control group p less than 0.001). There were 32 cesarean sections with live outcomes and 14 newborn infants with a weight below 1.5 kg survived. Our study shows that in patients with SLE planned rheumatologic care of the mother, with special obstetrical and perinatal attention, may reduce the high maternal and fetal morbidity/mortality.