NEWS: Outcomes in lupus pregnancies vastly improved

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Outcomes in lupus pregnancies vastly improved



Sep 28, 2005



Gandey



Toronto, ON - The perception that systemic lupus erythematosus (SLE)

pregnancies are especially risky is no longer accurate, researchers

report. Improvements in disease management and perinatal monitoring

have resulted in a significant decrease in pregnancy loss and a trend

toward fewer preterm deliveries. Published in the September 2005

issue of the Journal of Rheumatology, the group led by

(University of Toronto, ON) points out that these advances

highlight the importance of collaboration between rheumatologists and

perinatologists [1]. " Given these data, the description of SLE-

associated pregnancy could be revised to reflect a more positive

prognosis for mother and fetus. "

In an accompanying editorial [2], Dr Jill Buyon (Hospital for Joint

Diseases University School of Medicine, New York) writes, " On

balance, and her team are appropriate in advocating that the

conventional description of pregnancy in SLE be replaced by a more

optimistic view, with the caveat that a history of arterial

thrombosis, severe renal insufficiency, and pulmonary hypertension

are contraindications. "



" and her team are appropriate in advocating that the

conventional description of pregnancy in SLE be replaced by a more

optimistic view. "



As part of their analysis, and her team, which includes senior

author Dr Carl Laskin, director of the obstetric medicine program at

the University of Toronto, studied the pregnancy outcomes of their

SLE patients over the past three years. They also reviewed the

literature from the past 40 years—extracting pregnancy loss and

preterm delivery data from reports of postdiagnosis SLE pregnancies.

The researchers grouped the studies into five-year periods and

weighted the data according to sample size. They plotted group means

calculated for each study period using linear regression to determine

significance and compared the findings with population norms for the

same periods.

and colleagues found that the rate of loss in lupus pregnancies

decreased from a mean as high as 43% before 1975 to 17% in 2000-2003—

a frequency that approximates the loss rate in the general population

and includes both early and late losses. Specifically, 73 of 83 (88%)

pregnancies in the group's cohort resulted in a live birth.

Contraindications include thrombosis, renal insufficiency, and

pulmonary hypertension

The researchers say that the fall in the number of miscarriages in

lupus pregnancies may be due in large part to improved disease

management, particularly the identification and treatment of

secondary antiphospholipid syndrome. They do note, however, that

questions surrounding the optimum therapeutic regimen for women with

a history of thrombosis and recurrent pregnancy loss remain

controversial. and colleagues also point to a greater

understanding by clinicians and patients that inactive disease in

contrast to stable disease is an important consideration in reducing

both maternal and fetal morbidity.

" Doctors and patients are without question getting smarter when it

comes to lupus pregnancies, " Buyon said during an interview with

rheumawire. " More prepregnancy counseling is taking place, and women

are realizing that they should wait until they are in a state of

remission before becoming pregnant. "



" Optimism does not obviate the critical need for judicious

obstetrical care and the search for biomarkers. "



In her editorial, Buyon points out that while there is cause to

celebrate progress, " optimism does not obviate the critical need for

judicious obstetrical care and the search for biomarkers such as

complement-activation products that would help predict poor outcomes

beyond the influence of maternal disease or specific autoantibodies. "

She writes that although the and colleagues study did not

formally address whether pregnancy adversely affects maternal

disease, the authors do imply in their discussion that patients who

do not have severe organ disease or a history of life-threatening

complications in previous pregnancies should have a favorable course.

" While this wisdom is generally accepted, it is worthy of mention

that Lockshin and colleagues were instrumental in this regard over 20

years ago when they compared disease activity in pregnant patients

with SLE and nonpregnant patients matched for disease severity [3]. "

She explains, " There were no statistically significant differences in

the frequency of any disease activity marker studied, including

proteinuria, hypocomplementemia, anti-DNA antibodies, and therapy. "

http://www.jointandbone.org/viewArticle.do?primaryKey=569985