title: Lupus nephritis is associated with poor pregnancy outcomes in pregnant SLE patients in Cape Town: a retrospective analysis.
abstract: BACKGROUND
  Systemic lupus erythematosus (SLE) is a multi-system auto-immune disease common in females of child-bearing age. The effect of pregnancy on SLE and vice versa have not been well characterised in Africans. The aim of this study is to describe the pregnancy outcomes of patients with SLE presenting to the maternity department of Groote Schuur Hospital, Cape Town.
  
  
  METHODS
  This study was designed as a retrospective review of records of pregnant women known with SLE and followed-up at the maternity section of Groote Schuur Hospital. The duration of survey was from the 1(st) January 2003 to 31(st) December 2013.
  
  
  RESULTS
  There were 61 pregnancies reviewed in 49 patients; 80.3% of the pregnancies were in patients of mixed ancestry and the rest (19.7%) in black African patients. The mean age at presentation of the current pregnancy was 27.2 ± 5.0 years. Mean gestational age at presentation and delivery was 13.0 ± 6.0 weeks and 28.9 ± 9.8 weeks respectively and 47.5% of the pregnancies were in patients with lupus nephritis (LN). Thirty nine (63.9%) pregnancies reached the third trimester and 11.5% of all pregnancies ended in the first trimester. There was a lower number of live births to mothers of African ancestry than to those of mixed ancestry (p = 0.001). In 55.7% of the pregnancies, no flare was reported while a renal flare was reported in 23%. Pregnancies in patients with LN had higher frequencies of flares (58.6% vs 31.3%; p = 0.032), pre-eclampsia (34.5% vs 12.5%; p = 0.041), longer stay in hospital (12.0 ± 9.1 days vs 6.1 ± 5.1 days; p = 0.004) and low birth weight babies (1.94 ± 1.02 kg vs 2.55 ± 0.95 kg; p = 0.046) than in patients without LN. Only 36 (59%) of the neonates were discharged home alive and of these 2 (5.6%) were to mothers of black African ancestry (p = 0.001).
  
  
  CONCLUSIONS
  Increased lupus activity in pregnant SLE patients may account for the increased deaths of neonates born to SLE mothers. Patients of black African descent and those with LN tend to have a poorer outcome. A multi-disciplinary approach to the management of SLE patients (of child-bearing age or pregnant) needs to be further assessed for better outcomes.
authors.affiliation: Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
authors.forename: Lindisa
authors.initials: L
authors.lastname: Mbuli
authors.affiliation: South Africa National Bioinformatics Institute (SANBI), University of the Western Cape, Cape Town, South Africa.
authors.forename: Darlington
authors.initials: D
authors.lastname: Mapiye
authors.affiliation: Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
authors.forename: Ikechi
authors.initials: I
authors.lastname: Okpechi
mesh_terms: D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007902:Length of Stay; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008181:Lupus Nephritis / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000503:physiopathology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
keywords: Africans; Lupus; SLE; foetal; maternal; neonatal; pre-eclampsia; pregnancy