title: Maternal outcome in pregnant women with lupus nephritis. A prospective multicenter study.
abstract: Retrospective studies reported a high incidence of maternal complications in pregnant women with lupus. In this paper we prospectively assessed the rate of risk and the risk factors of maternal outcome in women with stable lupus nephritis who received pre-pregnancy counseling. This prospective multicenter study includes 71 pregnancies in 61 women with lupus nephritis who became pregnant between 2006 and 2013. Complete renal remission was present before pregnancy in 56 cases (78.9%) and mild active nephritis in 15 cases. All women underwent a screening visit before pregnancy and were closely monitored by a multidisciplinary team. Lupus anticoagulant, serum C3 and C4 complement fractions, anti-DNA antibodies, anti-C1q antibodies, anticardiolipin IgG and IgM antibodies, anti-beta2 IgG and IgM antibodies were tested at screening visit, at first, second, third trimester of pregnancy, and one year after delivery. Renal flares of lupus during or after pregnancy, pre-eclampsia, and HELLP syndrome were defined as adverse maternal outcomes. Fourteen flares (19.7%), six cases of pre-eclampsia (8.4%) and two cases of HELLP (2.8%) occurred during the study period. All flares responded to therapy and the manifestations of pre-eclampsia and HELLP were promptly reversible. Low C3, high anti-DNA antibodies and predicted all renal flares. High anti-C1q antibodies and low C4 predicted early flares. The body mass index (BMI) was associated with increased risk of late flares. History of previous renal flares and the presence of clinically active lupus nephritis at conception did not increase the risk of renal flares during pregnancy. History of renal flares before pregnancy, arterial hypertension, and longer disease predicted pre-eclampsia/HELLP. In pregnant women with lupus nephritis adverse maternal outcomes were relatively common but proved to be reversible when promptly diagnosed and treated. Immunological activity, arterial hypertension and BMI may predispose to maternal complications.
authors.affiliation: Nephrological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: gmoroni@policlinico.mi.it.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Moroni
authors.affiliation: Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
authors.affiliation: Nephrological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Giglio
authors.affiliation: Postgraduate School of Nephrology, Milano Bicocca University, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Imbasciati
authors.affiliation: Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Tani
authors.affiliation: Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Zen
authors.affiliation: Department of Reproductive Medicine and Child Development Division of Obstetrics and Gynecology, University of Pisa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Strigini
authors.affiliation: Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Zaina
authors.affiliation: Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.affiliation: Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy.
authors.forename: Mariele
authors.initials: M
authors.lastname: Gatto
authors.affiliation: Laboratory of Clinical Chemistry and Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: de Liso
authors.affiliation: Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Grossi
authors.affiliation: Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Meroni
authors.affiliation: Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy.
authors.forename: Gianfranca
authors.initials: G
authors.lastname: Cabiddu
authors.affiliation: Nephrological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
authors.affiliation: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.affiliation: Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Mosca
mesh_terms: D000328:Adult; D015415:Biomarkers; D018450:Disease Progression; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis; D006801:Humans; D008181:Lupus Nephritis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D063868:Patient Outcome Assessment; D011225:Pre-Eclampsia / Q000175:diagnosis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers
keywords: Lupus nephritis; Preeclampsia; Pregnancy; Renal flares; Systemic lupus erythematosus