The impact of increased lupus activity on obstetric outcomes.
OBJECTIVE
Systemic lupus erythematosus is associated with multiple adverse pregnancy outcomes. We examined the impact of disease activity on spontaneous abortions, perinatal mortality, preterm delivery, and birth weight.


METHODS
The study was designed to assess all pregnancies in a cohort of lupus patients who were observed prospectively from 1987 to 2002. At each visit, the physician's estimate of lupus activity was determined on a visual analog scale (high-activity lupus defined as a score of >or=2). Disease activity in each trimester was compared. We assessed the impact of high-activity lupus during pregnancy on gestational age, live birth rate, and small for gestational age babies. Potential confounders, including demographics of the women as well as maternal history of lupus, renal lupus, and antiphosphoplipid antibody syndrome, were analyzed through multivariate analysis.


RESULTS
Two hundred sixty-seven pregnancies were observed. Of these, 229 (85.8%) resulted in a live birth. High-activity lupus occurred in 57 pregnancies (21%). Fewer pregnancies among women with high-activity lupus ended with live births (77% versus 88% of those with low-activity lupus; P = 0.063). Full-term delivery was achieved in 15 pregnancies (26%) among women with high-activity lupus, compared with 127 pregnancies (61%) achieving full-term in those with no or mild lupus activity (P < 0.001). High-activity lupus in the first and second trimesters led to a 3-fold increase in pregnancy loss (miscarriages and perinatal mortality).


CONCLUSIONS
High-activity lupus during pregnancy leads to increased premature birth and a decrease in live births, with almost one-quarter of these pregnancies resulting in fetal loss. Pregnancies in lupus patients must be closely watched and treated during all trimesters to improve pregnancy outcomes.
Clowse
Megan E B
ME
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. meganclowse@hotmail.com <meganclowse@hotmail.com>
Magder
Laurence S
LS
Witter
Frank
F
Petri
Michelle
M
D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008180:Lupus Erythematosus, Systemic / Q000503:physiopathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011256:Pregnancy Outcome / Q000523:psychology*; D011446:Prospective Studies