Pregnant systemic lupus patients: impact of bad prognostic factors on disease flare

Background Systemic lupus erythematosus (SLE) affects reproductive aged women. Women with SLE can flare during pregnancy, in particular those who have active disease at conception or prior history of renal disease. These flares can lead to increased adverse pregnancy outcomes including fetal loss, preeclampsia, preterm birth, and small for gestational age infants. Objective To evaluate SLE Disease Activity Score (SLE-DAS) in the first trimester as a predictor of maternal flares in 2nd and 3rd trimester and adverse pregnancy outcome (APO) in SLE pregnant women. Patients and methods This cohort study was done on 50 SLE patients. Disease activity and maternal flares were assessed by applying SLE-DAS at first, second, and third trimester, subdivided into mild/moderate and severe. Follow-up: Visits were scheduled every trimester and postpartum to detect fetal outcomes. Results Regarding maternal outcomes, 22% of patients developed disease flare-up during pregnancy. We found significantly younger age at pregnancy and higher disease activity in the first trimester among flare group in 2nd and 3rd trimester than non-flare group ( p = 0.023, 0.000, respectively). Twenty-four percent of patients had at least one APO, 41 patients (82.0%) had live birth, 36% developed APO, 16% of them were preterm birth due to placental insufficiency, 16% developed IUFD ≥ 12 weeks, and 4% had small for gestational age infants. Conclusion APO in lupus patients was significantly associated with higher disease activity in the first trimester; so proper control of disease activity improves pregnancy outcomes.