title: Systemic lupus erythematosus and pregnancy: clinical evolution, maternal and perinatal outcomes and placental findings.
abstract: OBJECTIVE
  Systemic lupus erythematosus is a chronic disease that is more frequent in women of reproductive age. The relationship between lupus and pregnancy is problematic: maternal and fetal outcomes are worse than in the general population, and the management of flare-ups is difficult during this period. The aim here was to compare the outcomes of 76 pregnancies in 67 women with lupus, according to the occurrence or absence of flare-ups.
  
  
  METHODS
  An observational cohort clinical study evaluating the evolution of pregnant women with lupus who were receiving care at the prenatal outpatient clinic, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp), between 1995 and 2002.
  
  
  METHODS
  Data were collected on a precoded form. The women were divided into two groups according to the occurrence or absence of flare-ups, as defined by the systemic lupus erythematosus disease activity index (SLEDAI). The presence or absence of flare-ups and renal involvement was considered to be the independent variable and the other results were dependent variables.
  
  
  RESULTS
  Flare-ups occurred in 85.3% of cases, and were most significant when there was renal involvement. This was related to greater numbers of women with preeclampsia and poor perinatal outcome. Intrauterine growth restriction was more common in the women with active disease. Placental weight was significantly lower in the women with renal involvement.
  
  
  CONCLUSIONS
  Flare-ups and renal involvement in lupus patients during pregnancy are associated with increased maternal and perinatal complications.
authors.affiliation: Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. surita@unicamp.br
authors.forename: Fernanda Garanhani de Castro
authors.initials: FG
authors.lastname: Surita
authors.forename: Mary Angela
authors.initials: MA
authors.lastname: Parpinelli
authors.forename: Ema
authors.initials: E
authors.lastname: Yonehara
authors.forename: Fabiana
authors.initials: F
authors.lastname: Krupa
authors.forename: José Guilherme
authors.initials: JG
authors.lastname: Cecatti
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000209:etiology; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000276:immunology; D008181:Lupus Nephritis; D010920:Placenta / Q000473:pathology; D011225:Pre-Eclampsia / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000276:immunology; D011256:Pregnancy Outcome; D011295:Prenatal Care