A Systematic Review and Meta-Analysis of Pregnancy Outcomes in Patients with Systemic Lupus Erythematosus and Lupus Nephritis
Top Cited Papers
- 1 November 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 5 (11), 2060-2068
- https://doi.org/10.2215/cjn.00240110
Abstract
Background and objectives: Studies of the impact of systemic lupus erythematosus (SLE) and its pregnancy complications have yielded conflicting results. Major limitations of these studies relate to their small numbers of patients and retrospective designs. The aim of this study was to perform a systematic literature review of pregnancy outcomes in women with SLE and a meta-analysis of the association of lupus nephritis with adverse pregnancy outcomes. Design, setting, participants, & measurements: We searched electronic databases from 1980 to 2009 and reviewed papers with validity criteria. Random-effects analytical methods were used to evaluate pregnancy complications rates. Results: Thirty-seven studies with 1842 patients and 2751 pregnancies were included. Maternal complications included lupus flare (25.6%), hypertension (16.3%), nephritis (16.1%), pre-eclampsia (7.6%), and eclampsia (0.8%). The induced abortion rate was 5.9%, and when excluded, fetal complications included spontaneous abortion (16.0%), stillbirth (3.6%), neonatal deaths (2.5%), and intrauterine growth retardation (12.7%). The unsuccessful pregnancy rate was 23.4%, and the premature birth rate was 39.4%. Meta-regression analysis showed statistically significant positive associations between premature birth rate and active nephritis and increased hypertension rates in subjects with active nephritis or a history of nephritis. History of nephritis was also associated with pre-eclampsia. Anti-phospholipid antibodies were associated with hypertension, premature birth, and an increased rate of induced abortion. Conclusions: In patients with SLE, both lupus nephritis and anti-phospholipid antibodies increase the risks for maternal hypertension and premature births. The presented evidence further supports timing of pregnancy relative to SLE activity and multispecialty care of these patients.Keywords
This publication has 65 references indexed in Scilit:
- Maternal and foetal outcomes in pregnant patients with active lupus nephritisLupus, 2009
- Prevalence and significance of antiphospholipid antibodies in selected at-risk obstetrics cases: A comparative prospective studyJournal of Obstetrics and Gynaecology, 2009
- Pregnancy in systemic lupus erythematosus: a retrospective study from a developing communityClinical Rheumatology, 2007
- Maternal and fetal outcomes of 72 pregnancies in Argentine patients with systemic lupus erythematosus (SLE)Clinical Rheumatology, 2007
- Pregnancy outcome in women with pre-existing lupus nephritisJournal of Obstetrics and Gynaecology, 2004
- Pregnancy in past or present lupus nephritis: a study of 32 pregnancies from a single centreAnnals Of The Rheumatic Diseases, 2001
- Lupus Nephritis and PregnancyHypertension in Pregnancy, 1998
- Pregnancy in lupus nephropathyActa Obstetricia et Gynecologica Scandinavica, 1993
- Derivation of the sledai. A disease activity index for lupus patientsArthritis & Rheumatism, 1992
- Lupus Nephropathy and PregnancyNephron, 1984