Possible Key to Healthy Pregnancies in Women with Lupus Identified

Becoming pregnant when your lupus is clinically stable may be the key to fewer flares and a safer pregnancy, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.

Systemic lupus erythematosus, also called SLE or lupus, is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system, and/or other organs of the body. The most common symptoms include skin rashes and arthritis, often accompanied by fatigue and fever. Lupus occurs mostly in women, typically developing in individuals in their twenties and thirties – prime child-bearing age.

Pregnancy in lupus can be challenging for the patients and the doctors who treat them, and some women experience frequent disease flares during their pregnancies.

Researchers recently set out to determine the frequency, severity and timing of lupus flares in pregnant patients and the impact those flares have on their pregnancies. They studied 198 mainly Caucasian patients with lupus in a multi-center, prospective observational study. Participants were enrolled when they were 12 weeks or less along in their pregnancies. Of these women, 28 percent had previously suffered from kidney disease, and most patients were taking medications to treat their lupus. Researchers evaluated the participants each month to determine if they experienced any disease flares using the SLE Pregnancy Disease Activity Index—an instrument that takes into account the physiologic changes of pregnancy and incorporates measurements of lupus activity—and by following changes in clinical parameters and medications as well physician’s overall assessments of health.

Researchers found that the initial SLE Pregnancy Disease Activity Index did not change significantly at weeks 20 and 32. There were few disease flares among these patients during the study. Researchers reported six percent, five percent, and eight percent of patients had mild to moderate flares at 20 weeks, 32 weeks and post partum, respectively. They also reported zero, less than one percent and one and-a-half percent severe flares at 20 weeks, 32 weeks and post partum, respectively.

There were four severe flares during the 198 pregnancies: two involving the central nervous system, one involving kidney disease, and the other was an arthritis flare. Pregnancy complications—including fetal or neonatal death, preeclampsia and fetal growth restriction—occurred in 15 percent of patients. Abnormalities of blood associated with active lupus including hypocomplementemia and double stranded DNA were not associated with flares or poor pregnancy outcomes.

Overall, researchers determined that mild to moderate flares were very infrequent in pregnant women with lupus who were clinically stable at conception – even in the presence of hypocomplementemia or history of kidney disease. The outcomes of these women’s pregnancies were found to be favorable as well.