title: Primigravida is associated with flare in women with systemic lupus erythematosus.
abstract: The objective of this study was to identify risk factors associated with flare during pregnancy in women with systemic lupus erythematosus (SLE). We performed a retrospective analysis of pregnant women with SLE in a referral hospital. Flare was considered according to predetermined definitions. We analyzed 15 clinical, biochemical and immunological variables with a potential predictive value for relapse during pregnancy. We included 124 lupus pregnancies in 120 women. The relapse rate during pregnancy was 37.9% (47 episodes). The most common manifestations of flare were renal, joint, cutaneous and hematological. Patients with flare during pregnancy developed a higher frequency of preeclampsia and preterm delivery. In multivariate analysis, primigravida was a risk factor associated with any type of flare during pregnancy (OR 2.3, 95% CI 0.99-5.52, p = 0.05); on the other hand, primigravida (OR 3.6, 95% CI 1.19-11.3, p = 0.02), activity prior to pregnancy (OR 3.7, 95% CI 0.97-14.1, p = 0.05), and previous renal disease (OR 5.8, 95% CI 1.95-17.6, p = 0.001) were the principal risk factors associated with renal flare. The first pregnancy in women with SLE is associated with any type of flare. Disease activity is associated with preeclampsia and preterm delivery. Close monitoring is mandatory to identify relapses and timely treatment.
authors.affiliation: Rheumatology Department, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, México Universidad Nacional Autónoma de México, México City, Mexico.
authors.forename: M A
authors.initials: MA
authors.lastname: Saavedra
authors.affiliation: Rheumatology Department, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, México.
authors.forename: A
authors.initials: A
authors.lastname: Sánchez
authors.affiliation: Perinatology Department, Hospital de Gineco-Obstetricia No. 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, México.
authors.forename: S
authors.initials: S
authors.lastname: Morales
authors.affiliation: Hospital General de Chilpancingo Raymundo Abarca Alarcón, Chilpancingo, Guerrero, México.
authors.forename: J E
authors.initials: JE
authors.lastname: Navarro-Zarza
authors.affiliation: Epidemiology Division, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, México.
authors.forename: U
authors.initials: U
authors.lastname: Ángeles
authors.affiliation: Direction of Education and Research, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, México Universidad Nacional Autónoma de México, México City, Mexico reuma2003@yahoo.com.
authors.forename: L J
authors.initials: LJ
authors.lastname: Jara
mesh_terms: D000328:Adult; D005260:Female; D020073:Gravidity; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000503:physiopathology*; D008181:Lupus Nephritis / Q000150:complications / Q000453:epidemiology*; D015999:Multivariate Analysis; D011225:Pre-Eclampsia / Q000453:epidemiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Lupus pregnancy; lupus flare; predictors of lupus flare