Medicina

The Effect of Lupus Nephritis on Pregnancy Outcome and Fetal and Maternal Complications
DAFNA D. GLADMAN, ANU TANDON, DOMINIQUE IBAÑEZ, and MURRAY B. UROWITZ
ABSTRACT. Objective. To evaluate the effect of lupus nephritis on pregnancy with respect to fetal outcome, maternal complications, and lupus activity. Methods. All pregnancies seen between 1970 and 2003 in the Lupus Clinic were evaluatedfor the 3 outcomes. Renal disease was defined as the presence of nephrotic syndrome, dialysis, renal transplant, serum creatinine > 120 mmol/l, proteinuria, sterile hematuria and pyuria, or the presence of casts. Fetal complications were evaluated in pregnancies resulting in either live births or stillbirths. Generalized estimating equations were used to test for differences in outcomes betweenpregnancies with and without the presence of active renal disease. Repeated measures adjustments were made in the model for multiple pregnancies in the same mother. Results. There were 193 pregnancies in 104 women. Of these, 81 occurred in the presence of active renal disease during the study period, defined as 6 months prior to conception until the date of pregnancy outcome. One hundred twelvepregnancies were defined as nonrenal. No statistical difference was found in pregnancy outcome. Fetal complications were not different between the 2 groups with the exception of low birth weight and congenital malformations, which were observed more frequently in the renal group. Pregnancy-induced hypertension was more frequent in pregnancies with renal disease. Lupus flares were also more likely tooccur in pregnancies with renal disease compared to those without. Conclusion. Lupus nephritis in pregnancy does not lead to worsened pregnancy or fetal outcomes. Active renal disease, however, is associated with pregnancy-induced hypertension, as well as a flare of lupus activity during pregnancy. (First Release March 15 2010; J Rheumatol 2010;37:754–8; doi:10.3899/jrheum.090872) Key IndexingTerms: SYSTEMIC LUPUS ERYTHEMATOSUS LUPUS NEPHRITIS PREGNANCY COMPLICATIONS

Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease that most commonly affects women in their reproductive years1. While fertility does not appear to be an issue for women with SLE, there is increased fetal loss and impairment of fetal development2. We have previously shown that disease activity atconception is associated with flares of lupus during pregnancy3. Renal disease is a major manifestation in patients with SLE and is an important factor in morbidity and mortality1. The relationship between renal disease and pregnancy in SLE has been investigated and conflicting results have been
From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in The Rheumatic Diseases,Toronto Western Hospital, Toronto, Ontario, Canada. D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Co-Director, University of Toronto Lupus Clinic; A. Tandon, MD, Medical Resident;D. Ibañez, MSc, Biostatistician, Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital. Address correspondence to Dr. D. Gladman, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst Street, 1E-410B, Toronto, Ontario, Canada. E-mail: dafna.gladman@utoronto.ca Accepted for publication November 4, 2009. 754

reported4-8. We havefound that maternal renal disease was a strong predictor of adverse fetal outcome4. In a previous study we investigated the effect of pregnancy on lupus nephritis and found that during pregnancy, change in renal disease activity and deterioration in renal function are similar to those changes that occur in nonpregnant patients with lupus nephritis9. We investigated the effect of lupus nephritis...