Women diagnosed with lupus may find the results of a new study reassuring, which suggests that most pregnancies among women with the condition have good outcomes if their lupus is inactive. The study also identifies certain risk factors associated with poor outcomes in pregnancies among women with lupus.
Researchers at the Hospital for Special Surgery in New York City, NY, led the 10-year prospective, multi-center study PROMISSE (Predictors of pRegnancy Outcome: bioMarkers In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus) – the results of which are published in the Annals of Internal Medicine.
Lupus, or systemic lupus erythematosus, is an autoimmune disease that mostly affects women of childbearing age. The disease can attack healthy tissue in the skin, joints, kidneys, brain and other organs. Previously, lupus patients have been advised not to become pregnant, due to potential health risks for both mom and baby.
However, the results of PROMISSE – which researchers say is the largest multi-ethnic, multi-racial prospective study of lupus pregnancies – may help women with lupus to decide whether it is safe for them to become pregnant.
Across eight sites in the US and Canada, 385 pregnant women were enrolled in the study between September 2003 and December 2012. The women joined the study during the first 12 weeks of their pregnancies and they had inactive or stable mild to moderate lupus activity at that time.
The study found that 81% of the pregnancies in the study did not involve complications. In 5% of pregnancies, fetal or neonatal death occurred. Preterm deliveries occurred in 9% of the pregnancies, and 10% of the babies had a low birth weight.
Principal investigator Dr. Jane E. Salmon says of the results:
“Our findings provide a clear direction for counseling patients and reassuring women with inactive lupus. We also learned that patients with specific clinical features and certain antibodies that can be detected early in pregnancy by blood tests have an increased risk of serious pregnancy complications.”
The findings revealed that most of these pregnancy complications were linked to one or more of the following risk factors:
- A specific antiphospholipid antibody in the blood
- History of hypertension
- Low platelet count.
“It was exciting to see that severe lupus flares occurred in less than 3% of women during pregnancy,” says Dr. Salmon. She added:
“Lupus patients and their doctors can be confident of a good pregnancy outcome in most cases if lupus is quiescent when they become pregnant. Our findings now allow clinicians to identify the patients at high risk and manage them accordingly.”
Recently, the European League Against Rheumatism (EULAR) issued recommendations on reducing risk to women’s health and pregnancy in patients with lupus and antiphospholipid syndrome.
These included the recommendation that lupus patients who are planning a pregnancy should be counseled and managed after an assessment of risk, and that fertility preservation methods and assisted reproduction techniques may be considered.