title: Predictors of Pregnancy Outcomes in Patients With Lupus: A Cohort Study.
abstract: BACKGROUND
  Because systemic lupus erythematosus (SLE) affects women of reproductive age, pregnancy is a major concern.
  
  
  OBJECTIVE
  To identify predictors of adverse pregnancy outcomes (APOs) in patients with inactive or stable active SLE.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Multicenter.
  
  
  METHODS
  385 patients (49% non-Hispanic white; 31% with prior nephritis) with SLE in the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study. Exclusion criteria were urinary protein-creatinine ratio greater than 1000 mg/g, creatinine level greater than 1.2 mg/dL, prednisone use greater than 20 mg/d, and multifetal pregnancy.
  
  
  METHODS
  APOs included fetal or neonatal death; birth before 36 weeks due to placental insufficiency, hypertension, or preeclampsia; and small-for-gestational-age (SGA) neonate (birthweight below the fifth percentile). Disease activity was assessed with the Systemic Lupus Erythematosus Pregnancy Disease Activity Index and the Physician's Global Assessment (PGA).
  
  
  RESULTS
  APOs occurred in 19.0% (95% CI, 15.2% to 23.2%) of pregnancies; fetal death occurred in 4%, neonatal death occurred in 1%, preterm delivery occurred in 9%, and SGA neonate occurred in 10%. Severe flares in the second and third trimesters occurred in 2.5% and 3.0%, respectively. Baseline predictors of APOs included presence of lupus anticoagulant (LAC) (odds ratio [OR], 8.32 [CI, 3.59 to 19.26]), antihypertensive use (OR, 7.05 [CI, 3.05 to 16.31]), PGA score greater than 1 (OR, 4.02 [CI, 1.84 to 8.82]), and low platelet count (OR, 1.33 [CI, 1.09 to 1.63] per decrease of 50 × 109 cells/L). Non-Hispanic white race was protective (OR, 0.45 [CI, 0.24 to 0.84]). Maternal flares, higher disease activity, and smaller increases in C3 level later in pregnancy also predicted APOs. Among women without baseline risk factors, the APO rate was 7.8%. For those who either were LAC-positive or were LAC-negative but nonwhite or Hispanic and using antihypertensives, the APO rate was 58.0% and fetal or neonatal mortality was 22.0%.
  
  
  CONCLUSIONS
  Patients with high disease activity were excluded.
  
  
  CONCLUSIONS
  In pregnant patients with inactive or stable mild/moderate SLE, severe flares are infrequent and, absent specific risk factors, outcomes are favorable.
  
  
  BACKGROUND
  National Institutes of Health.
authors.forename: Jill P
authors.initials: JP
authors.lastname: Buyon
authors.forename: Mimi Y
authors.initials: MY
authors.lastname: Kim
authors.forename: Marta M
authors.initials: MM
authors.lastname: Guerra
authors.forename: Carl A
authors.initials: CA
authors.lastname: Laskin
authors.forename: Michelle
authors.initials: M
authors.lastname: Petri
authors.forename: Michael D
authors.initials: MD
authors.lastname: Lockshin
authors.forename: Lisa
authors.initials: L
authors.lastname: Sammaritano
authors.forename: D Ware
authors.initials: DW
authors.lastname: Branch
authors.forename: T Flint
authors.initials: TF
authors.lastname: Porter
authors.forename: Allen
authors.initials: A
authors.lastname: Sawitzke
authors.forename: Joan T
authors.initials: JT
authors.lastname: Merrill
authors.forename: Mary D
authors.initials: MD
authors.lastname: Stephenson
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cohn
authors.forename: Lamya
authors.initials: L
authors.lastname: Garabet
authors.forename: Jane E
authors.initials: JE
authors.lastname: Salmon
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005313:Fetal Death; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007234:Infant, Premature; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult