Background Systemic lupus erythematosus (SLE) directly impacts pregnancy outcomes, and few studies have analyzed the related risk factors for maternal and fetal/perinatal complications in Brazil. We described and analyzed the risk factors for maternal and fetal complications in SLE pregnancies at an outpatient clinic in the State of Amazonas, Northern Brazil. Methods Pregnancies that occurred after the SLE diagnosis between 2001 and 2020 were analyzed. Risk factors for adverse outcomes were determined using logistic regression. Results A total of 155 pregnancies from 109 women were included; the mean age was 28.2 (<InlineEquation ID="IEq1"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="42358_2025_467_Article_IEq1.gif" Format="GIF" Height="13" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">\(\pm\)</EquationSource> </InlineEquation>5.5) years, the median disease duration was 72 [36; 108] months, 56 (36.1%) had active disease prior to pregnancy, 39 (26.5%) had nephritis, 30 (20.3%) had cutaneous manifestations, and the incidence of disease activity during pregnancy was 29.7%; there was a 12.3% (95% CI, [4.2; 20.4]) increase in the proportion of patients with active disease, there were 35 (22.9%) fetal deaths, 26 (16.8%) cases of preeclampsia, 44 (37.3%) preterm births, 16 (16.2%) cases of low birth weight for gestational age, and 18 (18.8%) cases of intrauterine growth restriction. Risk factors for maternal events included immunological alterations (OR=3.02; 95% CI [1.11; 8.21]), renal involvement (OR=3.74; 95% CI [1.25; 11.21]), and disease activity before pregnancy (OR=1.30; 95% CI [1.04; 1.64]); the use of hydroxychloroquine before pregnancy was protective (OR=0.23; 95% CI [0.08; 0.67]). Risk factors for fetal events included the use of acetylsalicylic acid (ASA) during pregnancy (OR=5.22; 95% CI [1.33; 20.54]) and disease activity during pregnancy (OR=1.31; 95% CI [1.14; 1.52]); the use of antimalarials before and during pregnancy was protective (OR=0.14; 95% CI [0.04; 0.44]). According to the post-hoc analysis, the probability of a Type S error in the ASA association was 100%. The retrospective nature and the presence of missing data about laboratory tests are the main limitations of this study. Conclusion Pregnancy management in SLE presents a unique set of challenges that require a comprehensive and multidisciplinary approach. Careful monitoring of disease activity, appropriate medication management, and psychosocial support are essential for optimizing maternal and fetal health outcomes.

Systemic lupus erythematosus and risk factors for adverse outcomes in pregnancy: a single center retrospective cohort study in Northern Brazil

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2025年7月28日

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Sérgio Henrique Oliveira dos Santos,
Juliana Bühring,
Luiz Fernando de Souza Passos,
Bárbara Seabra Carneiro,
Domingos Sávio Nunes de Lima,
Sandra Lúcia Euzébio Ribeiro

摘要

Background

Systemic lupus erythematosus (SLE) directly impacts pregnancy outcomes, and few studies have analyzed the related risk factors for maternal and fetal/perinatal complications in Brazil. We described and analyzed the risk factors for maternal and fetal complications in SLE pregnancies at an outpatient clinic in the State of Amazonas, Northern Brazil.

Methods

Pregnancies that occurred after the SLE diagnosis between 2001 and 2020 were analyzed. Risk factors for adverse outcomes were determined using logistic regression.

Results

A total of 155 pregnancies from 109 women were included; the mean age was 28.2 ( \(\pm\) 5.5) years, the median disease duration was 72 [36; 108] months, 56 (36.1%) had active disease prior to pregnancy, 39 (26.5%) had nephritis, 30 (20.3%) had cutaneous manifestations, and the incidence of disease activity during pregnancy was 29.7%; there was a 12.3% (95% CI, [4.2; 20.4]) increase in the proportion of patients with active disease, there were 35 (22.9%) fetal deaths, 26 (16.8%) cases of preeclampsia, 44 (37.3%) preterm births, 16 (16.2%) cases of low birth weight for gestational age, and 18 (18.8%) cases of intrauterine growth restriction. Risk factors for maternal events included immunological alterations (OR=3.02; 95% CI [1.11; 8.21]), renal involvement (OR=3.74; 95% CI [1.25; 11.21]), and disease activity before pregnancy (OR=1.30; 95% CI [1.04; 1.64]); the use of hydroxychloroquine before pregnancy was protective (OR=0.23; 95% CI [0.08; 0.67]). Risk factors for fetal events included the use of acetylsalicylic acid (ASA) during pregnancy (OR=5.22; 95% CI [1.33; 20.54]) and disease activity during pregnancy (OR=1.31; 95% CI [1.14; 1.52]); the use of antimalarials before and during pregnancy was protective (OR=0.14; 95% CI [0.04; 0.44]). According to the post-hoc analysis, the probability of a Type S error in the ASA association was 100%. The retrospective nature and the presence of missing data about laboratory tests are the main limitations of this study.

Conclusion

Pregnancy management in SLE presents a unique set of challenges that require a comprehensive and multidisciplinary approach. Careful monitoring of disease activity, appropriate medication management, and psychosocial support are essential for optimizing maternal and fetal health outcomes.