Pregnancy outcomes poor prior to lupus diagnosis

Even before a diagnosis of Systemic lupus erythematosus, women who eventually develop the disease are more likely to experience poor pregnancy outcomes, Michigan-based researchers report in the American Journal of Obstetrics and Gynecology.

As lead author Dr. J. Patricia Dhar told, “poor fetal outcomes - stillbirths, preterm births and growth restricted infants - are seen in pregnancies that are complicated by lupus even before the disease is clinically apparent in the mother.”

“In other words,” she added, “the fetus does not thrive as well in the uterus of mothers who have an established diagnosis of lupus nor in those who are destined to develop lupus.”

Systemic lupus erythematosus or SLE is a chronic autoimmune disorder in which the immune system can confuse healthy and foreign tissues and sometimes attacks both. The disorder disproportionately affects women, particularly those of childbearing age.

Systemic lupus erythematosus (SLE) is a chronic, inflammatory autoimmune disorder. It may affect many organ systems including the skin, joints, and internal organs.

Causes, incidence, and risk factors
Normally, the immune system controls the body’s defenses against infection. In SLE and other autoimmune diseases, these defenses are turned against the body and rogue immune cells attack tissues. Antibodies may be produced that can react against the body’s blood cells, organs, and tissues. These lead immune cells to attack the affected systems, producing a chronic (long-term) disease.

For their study, Dhar of the Henry Ford Hospital, Detroit and colleagues looked at data for 148 lupus patients and almost 79,000 non-lupus patients who delivered at their institution over a period of about 8 years.

The final analysis was based on 15 pregnancies in women yet to be diagnosed with lupus, 69 pregnancies in women already diagnosed, and a control group of 51,000 women.

The yet-to-be diagnosed women received a diagnosis of lupus an average of 5 years after delivery. The women who already had lupus were diagnosed an average of 5 years before delivery.

Compared with the control group, the odds of experiencing stillbirth were more than 9 times greater in the yet-to-be diagnosed group, and close to 4 times greater in the diagnosed group.

The women in the lupus groups also had a significantly greater proportion of preterm births and infants categorized as being of very low birthweight.

The researchers point out that poor fetal outcomes are seen before appearance of the disease, which suggests a pre-disease state.

The fetus gives warning, Dhar concluded “that there is a problem with the mother before the mother has enough symptoms to warrant a diagnosis of lupus.”

SOURCE: American Journal of Obstetrics and Gynecology, October 2005.

Provided by ArmMed Media
Revision date: June 21, 2011
Last revised: by Dave R. Roger, M.D.