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Licensed Unlicensed Requires Authentication Published by De Gruyter September 25, 2019

Pregnancy outcomes in systemic lupus erythematosus (SLE) women

Aida Kalok , Rizna Abdul Cader , Ima Indirayani , Abdul Kadir Abdul Karim , Shamsul Azhar Shah , Nor Azlin Mohamed Ismail , Mohd Hashim Omar and Mohamad Nasir Shafiee EMAIL logo



Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory condition with multi-organ involvement predominantly affecting young women. There are very limited studies in pregnancy in Asian SLE patients and therefore we embarked on this study to identify pregnancy outcomes of Malaysian women with SLE.

Materials and methods

We performed a retrospective study of pregnancy outcomes in SLE patients in our institution from January 2007 to December 2014. A total of 71 pregnancies from 44 women were analysed.


The mean age of our cohort was 30.5 ± 3.9 years. The rate of active disease at conception, antiphospholipid syndrome and lupus nephritis were 22.5%, 32.4% and 57.7% respectively. SLE flare occurred in 33 out of 71 pregnancies whereas 19 pregnancies were complicated with preeclampsia. The livebirth rate for our cohort was 78.9%, whilst preterm delivery was 42.9%. On univariate analysis, active disease and flare in pregnancy were both strongly associated with foetal loss and preterm delivery. Lupus nephritis (p = 0.011), SLE flare (p = 0.008) and antiphospholipid syndrome (p = 0.032) significantly increased the risk of preeclampsia. Aspirin and hydroxychloroquine were protective against foetal loss [odds ratio (OR) 0.12] and preeclampsia (OR 0.25), respectively. On multivariate analysis, active disease was a predictor of SLE flare (p = 0.002) and foetal loss (p = 0.018) and SLE flare was the main predictor of preterm delivery (p = 0.006).


Pregnancies in women with SLE should be planned and aspirin and HCQ use were beneficial in reducing adverse pregnancy outcomes.

Author statement

  1. Research funding: None declared.

  2. Conflict of interest: Authors declare no conflict of interest.

  3. Ethical approval: Ethics approval was obtained from the University Research and Ethics Board (FF-2013-465).

  4. Informed consent: This is a retrospective study which involved analysis of patients data, who are being kept anonymous. Informed consent was not required.


[1] Pons-Estel GJ, Alarcón GS, Scofield L, Reinlib L, Cooper GS. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum. 2010;39:257–68.10.1016/j.semarthrit.2008.10.007Search in Google Scholar PubMed PubMed Central

[2] Clowse ME, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 2008;199:127.e1e6.10.1016/j.ajog.2008.03.012Search in Google Scholar PubMed PubMed Central

[3] Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthr Rheum. 2005;54:899e907.10.1002/art.21663Search in Google Scholar PubMed

[4] Fischer-Betz R, Specker C. Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome. Best Pract Res Clin Rheumatol. 2017;31:397–414.10.1016/j.berh.2017.09.011Search in Google Scholar PubMed

[5] Yamamoto Y, Aoki S. Systemic lupus erythematosus: strategies to improve pregnancy outcomes. Int J Womens Health. 2016;8:265–72.10.2147/IJWH.S90157Search in Google Scholar PubMed PubMed Central

[6] Ko HS, Ahn HY, Jang DG, Choi SK, Park YG, Park IY, et al. Pregnancy outcomes and appropriate timing of pregnancy in 183 pregnancies in Korean patients with SLE. Int J Med Sci. 2011;8:577–83.10.7150/ijms.8.577Search in Google Scholar PubMed PubMed Central

[7] Al Arfaj AS, Khalil N. Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus. 2010;19:1665–73.10.1177/0961203310378669Search in Google Scholar PubMed

[8] Teh CL, Wan SA, Cheong YK, Ling GR. Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia. Lupus. 2016;26:218–23.10.1177/0961203316664996Search in Google Scholar PubMed

[9] Phansenee S, Sekararithi R, Jatavan P, Tongsong T. Pregnancy outcomes among women with systemic lupus erythematosus: a retrospective cohort study from Thailand. Lupus. 2018;27:158–64.10.1177/0961203317721353Search in Google Scholar PubMed

[10] Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.10.1002/art.1780400928Search in Google Scholar PubMed

[11] Yee CS, Farewell VT, Isenberg DA, Griffiths B, Teh LS, Bruce IN, et al. The use of Systemic Lupus Erythematosus Disease Activity Index–2000 to define active disease and minimal clinically meaningful change based on data from a large cohort of systemic lupus erythematosus patients. Rheumatology (Oxford). 2011;50:982–8.10.1093/rheumatology/keq376Search in Google Scholar PubMed PubMed Central

[12] National Collaborating Centre for Women’s and Children’s Health (UK). Preterm Labour and Birth. London: National Institute for Health and Care Excellence (UK); 2015.Search in Google Scholar

[13] Royal College of Obstetricians and Gynaecologists. The Investigation and Treatment of Couples with Recurrent First trimester and Second-trimester Miscarriage. Green-top Guideline No. 17. RCOG (UK); 2011.Search in Google Scholar

[14] National Collaborating Centre for Women’s and Children’s Health (UK). Hypertension in pregnancy: diagnosis and management. Clinical Guideline [CG107]. London: National Institute for Health and Care Excellence (UK); 2010.Search in Google Scholar

[15] National Collaborating Centre for Women’s and Children’s Health (UK). Diabetes in pregnancy: management from preconception to the postnatal period. London: National Institute for Health and Care Excellence (UK); 2015.Search in Google Scholar

[16] Ideguchi H, Ohno S, Uehara T, Ishigatsubo Y. Pregnancy outcomes in Japanese patients with SLE: retrospective review of 55 pregnancies at a university hospital. Clin Rev Allergy Immunol. 2013;44:57–64.10.1007/s12016-011-8269-8Search in Google Scholar PubMed

[17] Liu J, Zhao Y, Song Y, Zhang W, Bian X, Yang J, et al. Pregnancy in women with systemic lupus erythematosus: a retrospective study of 111 pregnancies in Chinese women. J Matern Fetal Neonatal Med. 2012;25:261–6.10.3109/14767058.2011.572310Search in Google Scholar PubMed

[18] Kalok A, Peraba P, Shah SA, Mahdy ZA, Jamil MA, Kampan N, et al. Screening for gestational diabetes in low-risk women: effect of maternal age. Horm Mol Biol Clin Investig. 2017. DOI: 10.1515/hmbci-2017-0071.Search in Google Scholar PubMed

[19] Idris N, Hatikah CC, Murizah M, Rushdan M. Universal versus selective screening for detection of gestational diabetes mellitus in a Malaysian population. Malays Fam Physician. 2009;4:83–7.Search in Google Scholar

[20] Stanhope TJ, White WM, Moder KG, Smyth A, Garovic VD. Obstetric nephrology: lupus and lupus nephritis in pregnancy. Clin J Am Soc Nephrol. 2012;l7:2089–99.10.2215/CJN.12441211Search in Google Scholar PubMed

[21] Buyon JP, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, et al. Predictors of pregnancy outcomes in patients with lupus: a cohort study. Ann Intern Med. 2015;163:153–63.10.7326/M14-2235Search in Google Scholar PubMed PubMed Central

[22] Gladman DD, Tandon A, Ibañez D, Urowitz MB. The effect of lupus nephritis on pregnancy outcome and fetal and maternal complications. J Rheumatol. 2010;37:754–8.10.3899/jrheum.090872Search in Google Scholar PubMed

[23] Saavedra MA, Cruz-Reyes C, Vera-Lastra O, Romero GT, Cruz-Cruz P, Arias-Flores R, et al. Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy. Clin Rheumatol. 2012;31:813–9.10.1007/s10067-012-1941-4Search in Google Scholar PubMed

[24] Clowse ME, Magder LS, Petri M. The clinical utility of measuring complement and anti-dsDNA antibodies during pregnancy in patients with systemic lupus erythematosus. J Rheumatol. 2011;38:1012–16.10.3899/jrheum.100746Search in Google Scholar PubMed

[25] Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol. 2010;5:2060–8.10.2215/CJN.00240110Search in Google Scholar PubMed PubMed Central

[26] Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295–306.10.1111/j.1538-7836.2006.01753.xSearch in Google Scholar PubMed

[27] Abou-Nassar K, Carrier M, Ramsay T, Rodger MA. The association between antiphospholipid antibodies and placenta mediated complications: a systematic review and meta-analysis. Thromb Res. 2011;128:77–85.10.1016/j.thromres.2011.02.006Search in Google Scholar PubMed

[28] Mak A, Cheung MW-L, Cheak AA, Ho RC. Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression. Rheumatol Oxf Engl. 2010;49:281–8.10.1093/rheumatology/kep373Search in Google Scholar PubMed

[29] Imbasciati E, Tincani A, Gregorini G, Doria A, Moroni G, Cabiddu G, et al. Pregnancy in women with pre-existing lupus nephritis: predictors of fetal and maternal outcome. Nephrol Dial Transplant. 2009;24:519–25.10.1093/ndt/gfn348Search in Google Scholar PubMed

[30] Koh JH, Ko HS, Kwok SK, Ju JH, Park SH. Hydroxychloroquine and pregnancy on lupus flares in Korean patients with systemic lupus erythematosus. Lupus. 2015;24:210–17.10.1177/0961203314555352Search in Google Scholar PubMed

[31] Clowse ME. Lupus activity in pregnancy. Rheum Dis Clin North Am. 2007;33:237–52.10.1016/j.rdc.2007.01.002Search in Google Scholar PubMed PubMed Central

[32] Jung H, Bobba R, Su J, Shariati-Sarabi Z, Gladman DD, Urowitz M, et al. The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus. Arthritis Rheum. 2010;62:863–8.10.1002/art.27289Search in Google Scholar PubMed

Received: 2019-03-04
Accepted: 2019-07-11
Published Online: 2019-09-25

© 2019 Walter de Gruyter GmbH, Berlin/Boston

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