title: Pregnancy outcome in juvenile systemic lupus erythematosus: a Brazilian multicenter cohort study.
abstract: OBJECTIVE
  To determine pregnancy outcome and fetal loss risk factors in patients with juvenile systemic lupus erythematosus (JSLE).
  
  
  METHODS
  A total of 315 female patients with JSLE followed in 12 Brazilian pediatric rheumatology centers were consecutively selected. Menarche was observed in 298 (94.6%) patients. Patients' medical records were reviewed for pregnancy outcomes and demographic, clinical, and therapeutic data.
  
  
  RESULTS
  A total of 24 unplanned pregnancies occurred in 298 (8%) patients. The outcomes were 5 (21%) early fetal losses (prior to 16 wks gestation), 18 (75%) live births, and 1 (4%) death due to preeclampsia and premature birth. The frequencies of active diffuse proliferative glomerulonephritis, proteinuria > or = 0.5 g/day, and arterial hypertension at the beginning of pregnancy were higher in pregnancies resulting in fetal losses than in live births [60% vs 5% (p = 0.02), 60% vs 5% (p = 0.02), 60% vs 5% (p = 0.02), respectively]. JSLE pregnancies with fetal losses had a significantly higher mean SLE Disease Activity Index 2000 (SLEDAI-2K) at the start of pregnancy compared with those with live births (9.40 +/- 7.47 vs 3.94 +/- 6.00; p = 0.049). Four pregnancies were inadvertently exposed to intravenous cyclophosphamide therapy for renal involvement despite contraceptive prescriptions, resulting in fetal loss in 3 (p = 0.02). In multivariate analysis only intravenous cyclophosphamide use at start of pregnancy (OR 25.50, 95% CI 1.72-377.93, p = 0.019) remained as an independent risk factor for fetal loss.
  
  
  CONCLUSIONS
  We identified immunosuppressive therapy as the major contributing factor for fetal loss in JSLE, reinforcing the importance of contraception.
authors.affiliation: Paediatric Rheumatology Units of the University of São Paulo, Federal University of São Paulo, Federal University of Rio de Janeiro, Santa Casa of São Paulo, Brazil. clovisaas@icr.hcnet.usp.br
authors.forename: Clovis A A
authors.initials: CA
authors.lastname: Silva
authors.forename: Maria O
authors.initials: MO
authors.lastname: Hilario
authors.forename: Marilia V
authors.initials: MV
authors.lastname: Febronio
authors.forename: Sheila K
authors.initials: SK
authors.lastname: Oliveira
authors.forename: Rozana G
authors.initials: RG
authors.lastname: Almeida
authors.forename: Adriana R
authors.initials: AR
authors.lastname: Fonseca
authors.forename: Edson M
authors.initials: EM
authors.lastname: Yamashita
authors.forename: Marcos V
authors.initials: MV
authors.lastname: Ronchezel
authors.forename: Luciene L
authors.initials: LL
authors.lastname: Campos
authors.forename: Simone
authors.initials: S
authors.lastname: Appenzeller
authors.forename: Maria V
authors.initials: MV
authors.lastname: Quintero
authors.forename: Ana B
authors.initials: AB
authors.lastname: Santos
authors.forename: Ana C
authors.initials: AC
authors.lastname: Medeiros
authors.forename: Luciana M
authors.initials: LM
authors.lastname: Carvalho
authors.forename: Teresa C
authors.initials: TC
authors.lastname: Robazzi
authors.forename: Silvana P
authors.initials: SP
authors.lastname: Cardin
authors.forename: Eloisa
authors.initials: E
authors.lastname: Bonfa
mesh_terms: D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects; D002648:Child; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000009:adverse effects; D005260:Female; D005313:Fetal Death; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D049168:Pregnancy, Unplanned; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D003520:Cyclophosphamide