Promote Pregnancy Wellness: Data Can Help Guide Pregnancy Management in Lupus

AMSTERDAM—Clinicians who are counseling women with systemic lupus erythematosus (SLE) have the benefit of an array of new insights into factors linked with increased risk of pregnancy loss, how SLE therapies affect pregnancy and data on outcomes of children born to mothers with SLE, an expert said in a session at EULAR: the Annual European Congress of Rheumatology.

The bottom line is that serious problems in pregnancy in women with SLE are relatively rare—when the pregnancy is carefully planned and managed. Issues that do arise can often be resolved with proper counseling of patients before pregnancy and monitoring of children after birth, said Angela Tincani, MD, professor of rheumatology at the University of Brescia in Italy.

Complement as Biomarker
Researchers have found that complement levels could play a role in predicting pregnancy outcome. Reduced complement levels, as well as smaller increases in complement C3 from baseline to the first and second trimester, can predict loss of the pregnancy, Dr. Tincani said.

More recently, other findings have shown much the same thing in a different way: an increase in complement activation products in the first two to three weeks of pregnancy was predictive of an adverse pregnancy outcome even if levels of complement C3 and C4 stayed at normal levels.

“This … can be a very interesting biomarker to be used,” Dr. Tincani said. “These data show the complement system is implicated in pregnancy losses.”¹

Complications & Outcomes
A meta-analysis on maternal and pregnancy outcomes published last year—including 3,000 pregnancies in lupus patients and more than 300,000 pregnancies in women without lupus from 2001 to 2016—found that pregnant lupus patients are at 11 times higher risk of thromboembolic disease, at three times the risk of a premature birth and at 2.6 times the risk of having a baby with congenital defects.²

“In some circumstances, lupus patients can have an enormous number of problems compared to non-lupus patients,” Dr. Tincani said.

But the findings don’t paint a complete picture, she said. She pointed out the findings were made retrospectively, that some were derived from small studies and that it’s not known how the women were treated.

A study in which researchers prospectively followed pregnancies in women with lupus nephritis found that preeclampsia before the 34-week mark of pregnancy was increased. The study found that nephrophathy, hypertension and proteinuria were the most important predictors of complications during pregnancy.³

Another study of pregnant women with lupus nephritis who were followed prospectively and received multidisciplinary counseling, found that fetal loss was predicted by baseline arterial hypertension, positivity for lupus anticoagulant, anti-cardiolipin IgG antibodies and antibeta2 IgG antibodies.⁴