Pregnancy outcome in juvenile systemic lupus erythematosus: a Brazilian multicenter cohort study.
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.
Silva
Clovis A A
CA
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
Hilario
Maria O
MO
Febronio
Marilia V
MV
Oliveira
Sheila K
SK
Almeida
Rozana G
RG
Fonseca
Adriana R
AR
Yamashita
Edson M
EM
Ronchezel
Marcos V
MV
Campos
Luciene L
LL
Appenzeller
Simone
S
Quintero
Maria V
MV
Santos
Ana B
AB
Medeiros
Ana C
AC
Carvalho
Luciana M
LM
Robazzi
Teresa C
TC
Cardin
Silvana P
SP
Bonfa
Eloisa
E
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
D018501:Antirheumatic Agents; D003520:Cyclophosphamide