title: Specific systemic lupus erythematosus disease manifestations in the six months prior to conception are associated with similar disease manifestations during pregnancy.
abstract: Past studies have focused on aggregate lupus disease activity during pregnancy and have produced conflicting results. Our study evaluated lupus activity based on involvement of five specific organ systems during the six months prior to conception and during pregnancy. We assessed 147 pregnancies among 113 women followed at Brigham and Women's Lupus Center, 1990-2013. Organ-specific activity included hematologic disorder, nephritis, skin disease, arthritis, and serositis. We hypothesized that the presence of organ-specific activity six months prior to conception would increase the risk for that same type of activity during pregnancy. Our study population was 68% white; 100% had a positive ANA and 30% had a history of nephritis. Among women with organ-specific lupus activity during the six months before conception, the crude odds for the same type of activity during pregnancy was 7.7- to 32.5-fold higher compared to women without that type of activity immediately before conception. An adjusted logistic regression model also indicated significantly higher odds of organ-specific activity during pregnancy if that type of activity were present six months before conception. Approaching lupus based on specific organ systems may be a useful way for women and their physicians to consider the potential risk for disease activity during pregnancy.
authors.affiliation: Division of Rheumatology, Brigham and Women's Hospital, USA stedeschi1@partners.org.
authors.forename: S K
authors.initials: SK
authors.lastname: Tedeschi
authors.affiliation: Division of Rheumatology, Brigham and Women's Hospital, USA.
authors.forename: E
authors.initials: E
authors.lastname: Massarotti
authors.affiliation: Division of Rheumatology, Brigham and Women's Hospital, USA.
authors.forename: H
authors.initials: H
authors.lastname: Guan
authors.affiliation: Division of Rheumatology, Brigham and Women's Hospital, USA.
authors.forename: A
authors.initials: A
authors.lastname: Fine
authors.affiliation: Division of Rheumatology, Brigham and Women's Hospital, USA.
authors.forename: B L
authors.initials: BL
authors.lastname: Bermas
authors.affiliation: Division of Rheumatology, Brigham and Women's Hospital, USA.
authors.forename: K H
authors.initials: KH
authors.lastname: Costenbader
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D016015:Logistic Models; D008179:Lupus Erythematosus, Discoid / Q000453:epidemiology*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000453:epidemiology*; D008181:Lupus Nephritis / Q000453:epidemiology*; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine; D001379:Azathioprine
keywords: Systemic lupus erythematosus; hematologic changes; nephritis; pregnancy