Systemic lupus erythematosus Archives - Revista Brasileira de Ginecologia e Obstetrícia
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 04-14-2023;45(1):11-20
, , , , , Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with SLE may have severe life-threatening risks. The present study aimed to determine the prevalence of severe maternal morbidity (SMM) in patients with SLE and analyze the parameters that contributed to cases of greater severity.
This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at a University Hospital in Brazil. The pregnant women were divided in a control group without complications, a group with potentially life-threatening conditions (PLTC), and a group with maternal near miss (MNM).
The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with the control group (p = 0.0042; odds ratio [OR]: 12.05; 95% confidence interval [CI]: 1.5–96.6 for the MNM group and p = 0.0001; OR: 4.84; 95%CI: 2.2–10.8 for the PLTC group). Severe maternal morbidity increases the risk of longer hospitalization (p < 0.0001; OR: 18.8; 95%CI: 7.0–50.6 and p < 0.0001; OR: 158.17; 95%CI: 17.6–1424,2 for the PLTC and MNM groups, respectively), newborns with low birthweight (p = 0.0006; OR: 3.67; 95%CI: 1.7–7.9 and p = 0.0009; OR: 17.68; 95%CI: 2–153.6) for the PLTC and MNM groups, respectively] as well as renal diseases (PLTC [8.9%; 33/56; p = 0.0069] and MNM [78.6%; 11/14; p = 0.0026]). Maternal near miss cases presented increased risk for neonatal death (p = 0.0128; OR: 38.4; 95%CI: 3.3–440.3]), and stillbirth and miscarriage (p = 0.0011; OR: 7.68; 95%CI: 2.2–26.3]).
Systemic lupus erythematosus was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 04-14-2023;45(1):11-20
, , , , , Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with SLE may have severe life-threatening risks. The present study aimed to determine the prevalence of severe maternal morbidity (SMM) in patients with SLE and analyze the parameters that contributed to cases of greater severity.
This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at a University Hospital in Brazil. The pregnant women were divided in a control group without complications, a group with potentially life-threatening conditions (PLTC), and a group with maternal near miss (MNM).
The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with the control group (p = 0.0042; odds ratio [OR]: 12.05; 95% confidence interval [CI]: 1.5–96.6 for the MNM group and p = 0.0001; OR: 4.84; 95%CI: 2.2–10.8 for the PLTC group). Severe maternal morbidity increases the risk of longer hospitalization (p < 0.0001; OR: 18.8; 95%CI: 7.0–50.6 and p < 0.0001; OR: 158.17; 95%CI: 17.6–1424,2 for the PLTC and MNM groups, respectively), newborns with low birthweight (p = 0.0006; OR: 3.67; 95%CI: 1.7–7.9 and p = 0.0009; OR: 17.68; 95%CI: 2–153.6) for the PLTC and MNM groups, respectively] as well as renal diseases (PLTC [8.9%; 33/56; p = 0.0069] and MNM [78.6%; 11/14; p = 0.0026]). Maternal near miss cases presented increased risk for neonatal death (p = 0.0128; OR: 38.4; 95%CI: 3.3–440.3]), and stillbirth and miscarriage (p = 0.0011; OR: 7.68; 95%CI: 2.2–26.3]).
Systemic lupus erythematosus was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes.
, , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 02-17-2022;44(5):475-482
, , , , To assess the quality of life (QoL) of pregnant women with systemic lupus erythematosus (SLE) treated at a high-risk prenatal outpatient clinic during the third trimester of gestation.
An observational descriptive study was performed in a high-risk prenatal outpatient clinic. Women in the third trimester of pregnancy and undergoing antenatal care between July 2017 and July 2019 answered the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions divided into 4 domains (physical, psychological, social and environmental).
We interviewed 50 pregnant women with a mean gestational age of 30 weeks (standard deviation [SD]: 10 weeks) who were diagnosed with SLE. The average age of the participants was 30 years (SD: 14.85), and the average time since the diagnosis of SLE was of 9.06 years (SD: 6.8 years). Most participants had a partner, did not plan their pregnancy (76%), and did not use contraception prior to pregnancy (80%). The score of each domain ranges from 0 (the worst score) to 100 (the best score). The means ± SDs of the scores of the participants on each domain were: physical - 52.21 ± 18.44); psychological - 64.17 ± 18.56); social - 66.33 ± 27.09); and environmental - 64.56 (18.53). The means ± SDs of the general QoL, and health-related QoL items were of 70.50 ± 24.06 and 70.00 ± 30.72 respectively.
The physical domain presented the lowest scores compared with the other three domains. Pregnant women with SLE had high overall QoL scores, and their health-related QoL scores were also relatively high.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 02-17-2022;44(5):475-482
, , , , To assess the quality of life (QoL) of pregnant women with systemic lupus erythematosus (SLE) treated at a high-risk prenatal outpatient clinic during the third trimester of gestation.
An observational descriptive study was performed in a high-risk prenatal outpatient clinic. Women in the third trimester of pregnancy and undergoing antenatal care between July 2017 and July 2019 answered the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions divided into 4 domains (physical, psychological, social and environmental).
We interviewed 50 pregnant women with a mean gestational age of 30 weeks (standard deviation [SD]: 10 weeks) who were diagnosed with SLE. The average age of the participants was 30 years (SD: 14.85), and the average time since the diagnosis of SLE was of 9.06 years (SD: 6.8 years). Most participants had a partner, did not plan their pregnancy (76%), and did not use contraception prior to pregnancy (80%). The score of each domain ranges from 0 (the worst score) to 100 (the best score). The means ± SDs of the scores of the participants on each domain were: physical - 52.21 ± 18.44); psychological - 64.17 ± 18.56); social - 66.33 ± 27.09); and environmental - 64.56 (18.53). The means ± SDs of the general QoL, and health-related QoL items were of 70.50 ± 24.06 and 70.00 ± 30.72 respectively.
The physical domain presented the lowest scores compared with the other three domains. Pregnant women with SLE had high overall QoL scores, and their health-related QoL scores were also relatively high.
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 12-21-2020;42(11):705-711
, , , , , To determine pregnancy outcomes in women with systemic lupus erythematosus (SLE) who were treated with hydroxychloroquine in a tertiary center.
A retrospective study involving pregnant women with SLE who had antenatal follow-up and delivery in between 1 January 2007 and 1 January 2017. All participants were retrospectively enrolled and categorized into two groups based on hydroxychloroquine treatment during pregnancy.
There were 82 pregnancies included with 47 (57.3%) in the hydroxychloroquine group and 35 (42.7%) in the non-hydroxychloroquine group. Amongst hydroxychloroquine users, there were significantly more pregnancies with musculoskeletal involvement (p = 0.03), heavier mean neonatal birthweight (p = 0.02), and prolonged duration of pregnancy (p = 0.001). In non-hydroxychloroquine patients, there were significantly more recurrent miscarriages (p = 0.003), incidence of hypertension (p = 0.01) and gestational diabetes mellitus (p = 0.01) and concurrent medical illness (p = 0.005). Hydroxychloroquine use during pregnancy was protective against hypertension (p = 0.001), and the gestational age at delivery had significant effect on the neonatal birthweight (p = 0.001). However, duration of the disease had a significant negative effect on the neonatal birthweight (p = 0.016).
Hydroxychloroquine enhanced better neonatal outcomes and reduced adverse pregnancy outcomes and antenatal complications such as hypertension and diabetes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 12-21-2020;42(11):705-711
, , , , , To determine pregnancy outcomes in women with systemic lupus erythematosus (SLE) who were treated with hydroxychloroquine in a tertiary center.
A retrospective study involving pregnant women with SLE who had antenatal follow-up and delivery in between 1 January 2007 and 1 January 2017. All participants were retrospectively enrolled and categorized into two groups based on hydroxychloroquine treatment during pregnancy.
There were 82 pregnancies included with 47 (57.3%) in the hydroxychloroquine group and 35 (42.7%) in the non-hydroxychloroquine group. Amongst hydroxychloroquine users, there were significantly more pregnancies with musculoskeletal involvement (p = 0.03), heavier mean neonatal birthweight (p = 0.02), and prolonged duration of pregnancy (p = 0.001). In non-hydroxychloroquine patients, there were significantly more recurrent miscarriages (p = 0.003), incidence of hypertension (p = 0.01) and gestational diabetes mellitus (p = 0.01) and concurrent medical illness (p = 0.005). Hydroxychloroquine use during pregnancy was protective against hypertension (p = 0.001), and the gestational age at delivery had significant effect on the neonatal birthweight (p = 0.001). However, duration of the disease had a significant negative effect on the neonatal birthweight (p = 0.016).
Hydroxychloroquine enhanced better neonatal outcomes and reduced adverse pregnancy outcomes and antenatal complications such as hypertension and diabetes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 10-01-2018;40(10):587-592
To evaluate the effects of pregnancy in systemic lupus erythematosus (SLE) patients.
The present article is a retrospective cohort study. Datawere collected from medical records of pregnant women with SLE from January 2002 to December 2012 at Universidade Estadual de Campinas, in the city of Campinas, state of São Paulo, Brazil. Systemic lupus erythematosus and disease activity were defined according to the American College of Rheumatology and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria respectively. The means, standard deviations (SDs), percentages and correlations were performed using the SAS software, version 9.4 (SAS Institute Inc., Cary, NC, US).
We obtained data from 69 pregnancies in 58 women. During pregnancy, a new flare was observed in 39.2% (n = 27). The manifestations were most common in patients with prior kidney disease, and mainly occurred during the third quarter and the puerperium. Renal activity occurred in 24.6% (n = 17), and serious activity, in 16% (n = 11). Of all deliveries, 75% (n = 48) were by cesarean section. Twomaternal deaths occurred (3%). Preterm birth was themain complication in the newborns. The abortion rate was 8.7%. Severe SLEDAI during pregnancy was associated with prematurity (100%) and perinatal death (54%).
Thematernal-fetal outcome is worse in SLE when thewomen experience a flare during pregnancy. The best maternal-fetal outcomes occur when the disease is in remission for at least 6 months before the pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 10-01-2018;40(10):587-592
To evaluate the effects of pregnancy in systemic lupus erythematosus (SLE) patients.
The present article is a retrospective cohort study. Datawere collected from medical records of pregnant women with SLE from January 2002 to December 2012 at Universidade Estadual de Campinas, in the city of Campinas, state of São Paulo, Brazil. Systemic lupus erythematosus and disease activity were defined according to the American College of Rheumatology and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria respectively. The means, standard deviations (SDs), percentages and correlations were performed using the SAS software, version 9.4 (SAS Institute Inc., Cary, NC, US).
We obtained data from 69 pregnancies in 58 women. During pregnancy, a new flare was observed in 39.2% (n = 27). The manifestations were most common in patients with prior kidney disease, and mainly occurred during the third quarter and the puerperium. Renal activity occurred in 24.6% (n = 17), and serious activity, in 16% (n = 11). Of all deliveries, 75% (n = 48) were by cesarean section. Twomaternal deaths occurred (3%). Preterm birth was themain complication in the newborns. The abortion rate was 8.7%. Severe SLEDAI during pregnancy was associated with prematurity (100%) and perinatal death (54%).
Thematernal-fetal outcome is worse in SLE when thewomen experience a flare during pregnancy. The best maternal-fetal outcomes occur when the disease is in remission for at least 6 months before the pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 04-01-2018;40(4):209-224
To review the existing recommendations on the prenatal care of women with systemic lupus erythematosus (SLE), based on currently available scientific evidence.
An integrative review was performed by two independent researchers, based on the literature available in the MEDLINE (via PubMed), EMBASE and The Cochrane Library databases, using the medical subject headings (MeSH) terms “systemic lupus erythematosus” AND “high-risk pregnancy” OR “prenatal care.” Studies published in English between 2007 and 2017 were included; experimental studies and case reports were excluded. In cases of disagreement regarding the inclusion of studies, a third senior researcher was consulted. Forty titles were initially identified; four duplicates were excluded. After reading the abstracts, 7 were further excluded and 29 were selected for a full-text evaluation.
Systemic lupus erythematosus flares, preeclampsia, gestation loss, preterm birth, fetal growth restriction and neonatal lupus syndromes (mainly congenital heartblock) were the major complications described. The multidisciplinary team should adopt a specific monitoring, with particular therapeutic protocols. There are safe and effective drug options that should be prescribed for a good control of SLE activity.
Pregnant women with SLE present an increased risk for maternal complications, pregnancy loss and other adverse outcomes. The disease activity may worsen and, thereby, increase the risk of other maternal-fetal complications. Thus, maintaining an adequate control of disease activity and treating flares quickly should be a central goal during prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 04-01-2018;40(4):209-224
To review the existing recommendations on the prenatal care of women with systemic lupus erythematosus (SLE), based on currently available scientific evidence.
An integrative review was performed by two independent researchers, based on the literature available in the MEDLINE (via PubMed), EMBASE and The Cochrane Library databases, using the medical subject headings (MeSH) terms “systemic lupus erythematosus” AND “high-risk pregnancy” OR “prenatal care.” Studies published in English between 2007 and 2017 were included; experimental studies and case reports were excluded. In cases of disagreement regarding the inclusion of studies, a third senior researcher was consulted. Forty titles were initially identified; four duplicates were excluded. After reading the abstracts, 7 were further excluded and 29 were selected for a full-text evaluation.
Systemic lupus erythematosus flares, preeclampsia, gestation loss, preterm birth, fetal growth restriction and neonatal lupus syndromes (mainly congenital heartblock) were the major complications described. The multidisciplinary team should adopt a specific monitoring, with particular therapeutic protocols. There are safe and effective drug options that should be prescribed for a good control of SLE activity.
Pregnant women with SLE present an increased risk for maternal complications, pregnancy loss and other adverse outcomes. The disease activity may worsen and, thereby, increase the risk of other maternal-fetal complications. Thus, maintaining an adequate control of disease activity and treating flares quickly should be a central goal during prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 06-01-2015;37(6):272-277
DOI 10.1590/SO100-720320150005301
To evaluate the ovarian response after cyclophosphamide use (CPM) in patients
with systemic lupus erythematosus (SLE) and to correlate the age and cumulative
dose findings with changes in menstrual cycle and/or progression to ovarian
failure (OF).
This was a cross-sectional, retrospective study of 50 patients with a diagnosis
of SLE who used CFM with a clinical follow-up of at least 1 year. Included were
patients aged 12-40 years, who had undergone chemotherapy for SLE control and who
had regular menstrual cycles before the beginning of CPM treatment. Patients who
discontinued follow-up, who were followed up for less than one year or who had
irregular/absent menses before the beginning of CPM treatment were excluded. All
women studied were submitted to an interview and a questionnaire containing
questions about the pattern of the menstrual cycle before and after therapy, and
about the gestational periods and contraception. We asked if the patients had been
instructed about the side effects and consequences of CFM. Statistical analysis
was performed using the Student t-test and the Mann Whitney, χ2 and
nonparametric Kolmogorov-Smirnov tests.
The mean age of the patients included in the study was 30.8 years and the mean
age at the time of use of CPM was 25.3 years. After CFM, 24% of patients stopped
menstruating, 28% returned to regular cycles and 48% continued to have irregular
cycles. It was found that the patients who developed OF had longer disease
duration (12.3 years) than those who did not develop it (8.9 years). Thirteen
patients became spontaneously pregnant after CFM; however, 66% progressed to
abortion. The mean age of the patients who used CFM and developed OF was 28.1
years. Amenorrhea occurred in 50% of those aged 31-40 years, in 22.2% of those
aged 21-30 years and in 7.7% of those aged 12-20 years. Our study showed no
statistical correlation between cumulative dose and OF, although cumulative doses
greater than 11grams tended to promote some type of menstrual irregularity.
SLE disease duration, age at the time of treatment and the highest cumulative
doses are important predictors of OF after therapy with CFM. Pregnancy in lupus
patients is more likely to evolve with abortion after the use of chemotherapy. It
was seen that a small proportion of patients were aware of all the implications of
the drug. Therefore, additional studies should be conducted for further knowledge
and awareness of the importance of contraception and the preservation of ovarian
tissue on the part of the medical community.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 06-01-2015;37(6):272-277
DOI 10.1590/SO100-720320150005301
To evaluate the ovarian response after cyclophosphamide use (CPM) in patients
with systemic lupus erythematosus (SLE) and to correlate the age and cumulative
dose findings with changes in menstrual cycle and/or progression to ovarian
failure (OF).
This was a cross-sectional, retrospective study of 50 patients with a diagnosis
of SLE who used CFM with a clinical follow-up of at least 1 year. Included were
patients aged 12-40 years, who had undergone chemotherapy for SLE control and who
had regular menstrual cycles before the beginning of CPM treatment. Patients who
discontinued follow-up, who were followed up for less than one year or who had
irregular/absent menses before the beginning of CPM treatment were excluded. All
women studied were submitted to an interview and a questionnaire containing
questions about the pattern of the menstrual cycle before and after therapy, and
about the gestational periods and contraception. We asked if the patients had been
instructed about the side effects and consequences of CFM. Statistical analysis
was performed using the Student t-test and the Mann Whitney, χ2 and
nonparametric Kolmogorov-Smirnov tests.
The mean age of the patients included in the study was 30.8 years and the mean
age at the time of use of CPM was 25.3 years. After CFM, 24% of patients stopped
menstruating, 28% returned to regular cycles and 48% continued to have irregular
cycles. It was found that the patients who developed OF had longer disease
duration (12.3 years) than those who did not develop it (8.9 years). Thirteen
patients became spontaneously pregnant after CFM; however, 66% progressed to
abortion. The mean age of the patients who used CFM and developed OF was 28.1
years. Amenorrhea occurred in 50% of those aged 31-40 years, in 22.2% of those
aged 21-30 years and in 7.7% of those aged 12-20 years. Our study showed no
statistical correlation between cumulative dose and OF, although cumulative doses
greater than 11grams tended to promote some type of menstrual irregularity.
SLE disease duration, age at the time of treatment and the highest cumulative
doses are important predictors of OF after therapy with CFM. Pregnancy in lupus
patients is more likely to evolve with abortion after the use of chemotherapy. It
was seen that a small proportion of patients were aware of all the implications of
the drug. Therefore, additional studies should be conducted for further knowledge
and awareness of the importance of contraception and the preservation of ovarian
tissue on the part of the medical community.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 01-12-2010;31(11):534-539
DOI 10.1590/S0100-72032009001100002
PURPOSE: to analyze the ophthalmic artery functioning in pregnant women with systemic lupus erythematosus (PL) without active renal disease as compared to non-pregnant women with lupus (NPL) without active renal disease, and to normal pregnant women (PN). METHODS: observational study that analyzed ophthalmic artery dopplervelocimetric variables of 20 PN, 10 PL and 17 NPL women. The variables analyzed were: pulsatility index (PI), final diastolic velocity (FDV) and velocity peak ratio (VPR). Mean and standard deviation of these indexes were calculated. For group mean comparison, analysis of variance (ANOVA) and the post-hoc Tukey test have been used, with confidence interval of 95% (p<0.05). RESULTS: the PN group showed the following means and standard deviations of ophthalmic artery parameters: PI=2,4±0,3; VPR=0,5±0,1 e FDV=5,1±2,1 cm/s. The PL and NPL groups showed the following values, respectively: PI=2,0±0,4 and 1,9±0,4; VPR=0,6±0,1 and 0,6±0,1; FDV=9,7±3,9 cm/s and 8,1±4,3 cm/s. There was not significant mean difference between the PL and NPL groups for PI, VPR or FDV. However, statistically significant mean differences were observed between PN and PL for PI, VPR and FDV, with higher values of FDV and VPR in the PL group. CONCLUSIONS: there was a reduction of ophthalmic artery vascular impedance with orbital hyperfusion in the two groups of women with lupus erythematosus as compared to normal pregnant women. These results may help to improve the understanding on pathophysiology of systemic lupus erythematosus. In addition, the present method may be applied in future studies as a complementary procedure for the differential diagnosis between pre-eclampsia and renal failure due to lupus.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 01-12-2010;31(11):534-539
DOI 10.1590/S0100-72032009001100002
PURPOSE: to analyze the ophthalmic artery functioning in pregnant women with systemic lupus erythematosus (PL) without active renal disease as compared to non-pregnant women with lupus (NPL) without active renal disease, and to normal pregnant women (PN). METHODS: observational study that analyzed ophthalmic artery dopplervelocimetric variables of 20 PN, 10 PL and 17 NPL women. The variables analyzed were: pulsatility index (PI), final diastolic velocity (FDV) and velocity peak ratio (VPR). Mean and standard deviation of these indexes were calculated. For group mean comparison, analysis of variance (ANOVA) and the post-hoc Tukey test have been used, with confidence interval of 95% (p<0.05). RESULTS: the PN group showed the following means and standard deviations of ophthalmic artery parameters: PI=2,4±0,3; VPR=0,5±0,1 e FDV=5,1±2,1 cm/s. The PL and NPL groups showed the following values, respectively: PI=2,0±0,4 and 1,9±0,4; VPR=0,6±0,1 and 0,6±0,1; FDV=9,7±3,9 cm/s and 8,1±4,3 cm/s. There was not significant mean difference between the PL and NPL groups for PI, VPR or FDV. However, statistically significant mean differences were observed between PN and PL for PI, VPR and FDV, with higher values of FDV and VPR in the PL group. CONCLUSIONS: there was a reduction of ophthalmic artery vascular impedance with orbital hyperfusion in the two groups of women with lupus erythematosus as compared to normal pregnant women. These results may help to improve the understanding on pathophysiology of systemic lupus erythematosus. In addition, the present method may be applied in future studies as a complementary procedure for the differential diagnosis between pre-eclampsia and renal failure due to lupus.