title: Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy.
abstract: Previous reports suggest that renal involvement before pregnancy or active renal disease during pregnancy may be associated with poor fetal and maternal outcomes in systemic lupus erythematosus (SLE) women. We report our experience of fetal and maternal complications in pregnant lupus women with and without previous lupus nephritis. We analyzed the clinical records of pregnant SLE patients attended in a tertiary reference center during a 5-year period. Patients were allocated into two groups according to the presence or absence of previous lupus nephritis. Women were evaluated monthly during pregnancy and at least 1 month postpartum. Maternal and fetal outcomes of pregnancy were abstracted. We included 95 pregnancies in 92 patients. Compared with pregnant women without lupus nephritis (n = 60), pregnancies with previous lupus nephritis (n = 35) were associated with a higher risk of maternal complications (88.5% vs. 43.3%, p = 0.00001), higher rate of lupus flares (54.2% vs. 25%, p = 0.004), and renal flares (45.7% vs. 6.6%, p = 0.00001), but most of which in most instances were reversible. On the other hand, fetal outcome was similar in both groups. Multivariate analysis showed that previous lupus nephritis and active lupus at conception were predictors of adverse maternal outcome. Pregnancies in women with previous lupus nephritis had a higher rate of maternal complications in comparison with those without. However, fetal prognosis was similar in both groups.
authors.affiliation: Rheumatology Department, Hospital de Especialidades Dr. Antonio Fraga Mouret, Mexico City, Mexico.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Saavedra
authors.forename: Claudia
authors.initials: C
authors.lastname: Cruz-Reyes
authors.forename: Olga
authors.initials: O
authors.lastname: Vera-Lastra
authors.forename: Griselda T
authors.initials: GT
authors.lastname: Romero
authors.forename: Polita
authors.initials: P
authors.lastname: Cruz-Cruz
authors.forename: Rafael
authors.initials: R
authors.lastname: Arias-Flores
authors.forename: Luis J
authors.initials: LJ
authors.lastname: Jara
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008181:Lupus Nephritis / Q000188:drug therapy / Q000453:epidemiology*; D008800:Mexico / Q000453:epidemiology; D015999:Multivariate Analysis; D011241:Prednisone / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011379:Prognosis
chemical_list: D000962:Antimalarials; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone