Pregnancy outcomes and appropriate timing of pregnancy in 183 pregnancies in Korean patients with SLE

Hyun Sun Ko, Hyun Young Ahn, Dong Gyu Jang, Sae-Kyung Choi, Yong-Gyu Park, In Yang Park, Guisera Lee, Sung-Hwan Park, Jong Chul Shin, Hyun Sun Ko, Hyun Young Ahn, Dong Gyu Jang, Sae-Kyung Choi, Yong-Gyu Park, In Yang Park, Guisera Lee, Sung-Hwan Park, Jong Chul Shin

Abstract

This study was undertaken to investigate the pregnancy outcomes in patients with systemic lupus erythematosus (SLE) and the appropriate timing of pregnancy. We performed a retrospective evaluation of 183 pregnancies with SLE at Catholic University Medical Center during the 13-year period from 1998 to 2010. Pregnancy outcomes were compared according to SLE characteristics. The predictive value of the different cut-off points of the stable period before conception on adverse pregnancy outcomes was calculated by ROC (Receiver operating characteristics) curve analysis. In multivariate analysis, the presence of antiphospholipid antibodies (aPLs) increased the risk of pregnancy loss (p<0.0001) and premature birth (p=0.0040). Active disease at conception increased the risk of premature birth (p< 0.0001) and complications (IUGR, PIH, or both) (p= 0.0078). The other predictor of complications was found to be lupus flare (p=0.0252). At a cut-off level of stable period of 4 months before conception, sensitivity and specificity were 70.8% and 53.2%, 71.4% and 61.5%, and 63.6 % and 59.8 %, respectively on reducing pregnancy loss, premature birth, and complications. Pregnancies with aPLs, active disease at conception and SLE flares are at a higher risk of adverse outcomes. It is essential that disease activity remains stable at least 4 months before conception, for favorable pregnancy outcomes.

Keywords: Disease activity; Pregnancy outcomes; Systemic lupus erythematosus.

Conflict of interest statement

Conflict of Interest: We declare that there are no conflicts of interest and that the study has met institutional review board approval. The study has not been previously published in any form or shape.

Figures

Figure 1
Figure 1
ROC curve for prediction of adverse pregnancy outcomes. (A) ROC curve for prediction of pregnancy loss by the stable period of SLE. At a cut-off of 4 month, sensitivity was 70.8% and specificity 53.2% on reducing pregnancy loss. (B) ROC curve for prediction of premature birth by the stable period of SLE. At a cut-off of 4 month, sensitivity was 71.4% and specificity 61.5% on reducing premature birth. (C) ROC curve for prediction of complications during pregnancy (PIH, IUGR, or both) by the stable period of SLE. At a cut-off of 4 month, sensitivity was 63.6 % and specificity was 59.8 % on reducing complications of IUGR, PIH, or both.
Figure 1
Figure 1
ROC curve for prediction of adverse pregnancy outcomes. (A) ROC curve for prediction of pregnancy loss by the stable period of SLE. At a cut-off of 4 month, sensitivity was 70.8% and specificity 53.2% on reducing pregnancy loss. (B) ROC curve for prediction of premature birth by the stable period of SLE. At a cut-off of 4 month, sensitivity was 71.4% and specificity 61.5% on reducing premature birth. (C) ROC curve for prediction of complications during pregnancy (PIH, IUGR, or both) by the stable period of SLE. At a cut-off of 4 month, sensitivity was 63.6 % and specificity was 59.8 % on reducing complications of IUGR, PIH, or both.
Figure 1
Figure 1
ROC curve for prediction of adverse pregnancy outcomes. (A) ROC curve for prediction of pregnancy loss by the stable period of SLE. At a cut-off of 4 month, sensitivity was 70.8% and specificity 53.2% on reducing pregnancy loss. (B) ROC curve for prediction of premature birth by the stable period of SLE. At a cut-off of 4 month, sensitivity was 71.4% and specificity 61.5% on reducing premature birth. (C) ROC curve for prediction of complications during pregnancy (PIH, IUGR, or both) by the stable period of SLE. At a cut-off of 4 month, sensitivity was 63.6 % and specificity was 59.8 % on reducing complications of IUGR, PIH, or both.

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