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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (2): 189-193    DOI: 10.31083/j.ceog.2020.02.5043
Original Research Previous articles | Next articles
Pregnancy outcomes and risk factors in pregnant women with systemic lupus erythematosus
Li Li Zhang1, Hua Shu2, *(), Shuai Zhang3, Tian Tian Wang3, Lan Lan Zhang4
1Department of Rheumatology Immunologys, Affiliated Hospital of Jining Medical College, Jining, P.R. China
2Department of Obstetrics, Affiliated Hospital of Jining Medical College, Jining, P.R. China
3Department of Infection, Jining Infectious Disease Hospital, Jining, P.R. China
4Department of Internal Medicine, Jining Psychiatric Hospital, Jining, P.R. China
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Abstract  Objective: To analyze the pregnancy outcomes and risk factors in pregnant women with systemic lupus erythematosus (SLE), for providing a reference for the clinical diagnosis and treatment of the SLE. Materials and Methods: Seventy-eight SLE patients with 82 pregnancies were enrolled in this study. The general information of patients, maternal history data, clinical symptoms, and laboratory examination data one to three months before pregnancy, during pregnancy, at delivery and after childbirth, drug treatment, and pregnancy outcomes were collected. The single factor and logistic regression analyses of the risk factors related to SLE with deterioration and fetal loss were performed. Results: The single-factor analysis showed that there was significant difference in complement 3, 24-hour urinary protein, anti-dsDNA antibody, anti-CL antibody, pre-pregnancy prednisone dose, and SLE disease activity index (SLEDAI) between SLE with deterioration group and SLE without deterioration group, respectively (p < 0.05 or p < 0.01), with significant difference in complement 3, combined antiphospholipid syndrome (APS), SLEDAI, and SLE deterioration during pregnancy between fetal loss group and live birth group, respectively (p < 0.01). The multi-factor regression analysis showed that, the complement 3 and SLEDAI were the main risk factors of SLE with deterioration during pregnancy, and the combined APS and SLEDAI were the main risk factors of fetal loss. Conclusion: The pregnancy has a high risk in women with SLE. The complement 3 and SLEDAI are the main risk factors of SLE with deterioration during pregnancy, and the combined APS and SLEDAI are the main risk factors of fetal loss. The reasonable and effective strategies should be formulated based on these factors, in order to reduce the risk of adverse pregnancy outcomes.
Key words:  Systemic lupus erythematosus      Pregnancy      Outcomes      Risk factors     
Published:  15 April 2020     
*Corresponding Author(s):  Hua Shu     E-mail:  shuhuajn@126.com

Cite this article: 

Li Li Zhang, Hua Shu, Shuai Zhang, Tian Tian Wang, Lan Lan Zhang. Pregnancy outcomes and risk factors in pregnant women with systemic lupus erythematosus. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 189-193.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.02.5043     OR     https://ceog.imrpress.com/EN/Y2020/V47/I2/189

Table 1  — Single-factor analysis of factors for SLE with deterioration during pregnancy.
Index SLE with deterioration SLE without deterioration t/χ2 p
n 31 51
Age (years) 25.23 ± 3.14 26.12 ± 3.46 -1.169 0.246
Disease course (years) 5.45 ± 2.37 4.67 ± 1.98 1.604 0.113
WBC (× 109 /L) 7.13 ± 2.45 7.67 ± 1.64 -1.196 0.235
Hemoglobin (g/L) 92.59 ± 26.03 88.12 ± 19.26 0.890 0.376
Platelets (× 109 /L) 156.33 ± 34.58 163.73 ± 28.52 -1.050 0.297
ESR (mm/h) 21.68 ± 5.78 19.56 ± 5.18 1.720 0.089
Serum albumin (g/L) 28.93 ± 5.12 30.94 ± 6.27 -1.505 0.136
Serum globulin (g/L) 30.93± 5.68 32.45 ± 4.33 -1.368 0.175
CRP (mg/L) 3.15 ± 0.67 2.87 ± 0.78 1.660 0.101
IgG (g/L) 16.94 ± 3.78 17.33 ± 2.56 -0.557 0.580
IgA (g/L) 1.87 ± 0.56 1.99 ± 0.58 -0.920 0.360
IgM (g/L) 1.11 ± 0.31 1.25 ± 0.38 -1.730 0.088
Complement 3 (g/L) 0.81 ± 0.26 0.98 ± 0.22 -3.166 0.002
Complement 4 (g/L) 0.13 ± 0.05 0.15 ± 0.06 -1.555 0.124
24h UP (g/24h) 0.99 ± 0.34 0.74 ± 0.38 3.003 0.004
Positive anti-dsDNA antibody [n(%)] 13 (41.94) 8 (15.67) 6.9732 0.008
Positive anti-CL antibody [n(%)] 18 (58.06) 15 (29.41) 6.5822 0.010
Pre-pregnancy prednisone dose [n(%)] 6.762 0.009
≥ 10 mg/day 16 (51.61) 12 (23.53)
< 10 mg/day 15 (48.39) 39 (76.47)
SLEDAI [n(%)] 8.701 0.003
≥ 5 points 18 (58.06) 13 (25.49)
< 5 points 13 (41.94) 38 (74.51)
Table 2  — Multi-factor regression analysis of factors for SLE with deterioration during pregnancy.
Variable B S.E. Wald df Sig. Exp(B) 95% C.I. for Lower EXP(B)
Upper
Complement 3 5.341 2.060 6.721 1 0.012 208.771 3.681 11841.894
24h UP -1.679 2.133 0.619 1 0.431 0.187 0.003 12.210
Anti-dsDNA antibody 2.872 1.498 3.675 1 0.055 17.672 0.938 333.091
Anti-CL antibody 0.165 0.145 1.288 1 0.256 1.179 0.887 1.569
Pre-pregnancy prednisone dose 3.127 2.017 2.403 1 0.121 22.794 0.438 1187.525
SLEDAI 4.263 1.673 6.491 1 0.011 71.045 2.674 1887.362
Constant -14.828 7.661 3.746 1 0.053 0.000
Figure 1.  Receiver operating characteristic curves of complement 3 and SLEDAI for predicting systemic lupus erythematosus with deterioration. SLEDAI: systemic lupus erythematosus disease activity index.

Figure 2.  Receiver operating characteristic curves of combined APS and SLEDAI for predicting fetal loss. APS: antiphospholipid syndrome; SLEDAI: systemic lupus erythematosus disease activity index.

Table 3  — Single-factor analysis of factors for fetal outcome.
Index Fetal loss Live birth t/χ2 p
n 27 55
Age (years) 26.32 ± 3.26 25.34 ± 3.18 1.301 0.197
Disease course (years) 5.61 ± 2.48 4.49 ± 2.72 1.802 0.075
WBC (× 109 /L) 7.19 ± 2.66 7.55 ± 1.87 -0.710 0.480
Hemoglobin (g/L) 93.44 ± 22.67 87.89 ± 21.33 1.085 0.281
Platelets (× 109 /L) 161.45 ± 35.77 176.67 ± 39.83 -1.679 0.097
ESR (mm/h) 21.78 ± 4.83 19.94 ± 4.79 1.630 0.107
Serum albumin (g/L) 28.47 ± 6.72 30.37 ± 5.83 -1.318 0.191
Serum globulin (g/L) 29.97 ± 6.77 31.95 ± 4.84 -1.521 0.132
CRP (mg/L) 3.12 ± 0.67 2.79 ± 0.85 1.764 0.082
IgG (g/L) 16.57 ± 3.67 17.57 ± 2.84 -1.358 0.178
IgA (g/L) 1.92 ± 0.54 1.98 ± 0.52 -0.485 0.629
IgM (g/L) 1.09 ± 0.32 1.24 ± 0.38 -1.765 0.081
Complement 3 (g/L) 0.77 ± 0.22 0.93 ± 0.25 -2.829 0.006
Complement 4 (g/L) 0.14 ± 0.06 0.16 ± 0.05 -1.592 0.115
24h UP (g/24h) 0.94 ± 0.31 0.79 ± 0.42 1.647 0.104
Positive anti-dsDNA antibody [n(%)] 8 (29.63) 13 (23.64) 0.341 0.559
Positive anti-CL antibody [n(%)] 14 (51.85) 19 (34.55) 2.256 0.133
Combined APS 7 (25.93) 2 (3.64) 9.208 0.002
Pre-pregnancy prednisone dose [n(%)] 1.898 0.168
≥ 10 mg/day 12 (44.44) 16 (29.09)
< 10 mg/day 16 (55.56) 39 (70.91)
SLEDAI [n(%)] 7.880 0.005
≥ 5 points 16 (59.26) 15 (27.27)
< 5 points 11 (40.74) 40 (72.73)
SLE deterioration [n(%)] 16 (59.26) 15 (27.27) 7.880 0.005
Table 4  — Multi-factor regression analysis of factors for fetal loss.
Variable B S.E. Wald df Sig. Exp(B) 95% C.I. for Lower EXP(B)
Upper
Complement 3 2.183 1.560 1.958 1 0.162 8.869 0.417 188.549
Combined APS 3.269 1.523 4.610 1 0.032 26.296 1.330 519.958
SLEDAI 4.377 1.562 7.854 1 0.005 79.612 3.728 1699.958
SLE deterioration 0.086 0.135 0.409 1 0.523 1.090 0.837 1.420
Constant -8.178 5.950 1.889 1 0.169 0.000
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