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Original ArticleOpen Access
Pregnancy and Disease Outcome in Patients with Systemic Lupus Erythematosus (SLE): A Study at Srinagarind Hospital
Foocharoen C 
,
Nanagara R ,
Salang L ,
Suwannaroj S ,
Mahakkanukrauh A
,
Nanagara R ,
Salang L ,
Suwannaroj S ,
Mahakkanukrauh A Background: Systemic lupus erythematosus (SLE) is a multi-system involvement autoimmune disease that
commonly occurs in childbearing age women. During pregnancy and postpartum period, disease activity may
be severe or unchanged. Disease flare during pregnancy consistently affects pregnancy outcome.
Objective: To study pregnancy outcomes and predictive factor for disease flare during pregnancy in SLE
patients.
Material and Method: Retrospective descriptive study was performed. The study population was pregnant
SLE patients who were treated between January 1997 and December 2006 at Department of Obstetrics-
Gynecologic and Medicine, Srinagarind Hospital, Khon Kaen University, Thailand.
Result: The medical records of 37 pregnant SLE patients were reviewed. Of these, 33 cases gave delivery at
Srinagarind Hospital. Mean age was 27.3 + 3.26 years, and mean disease duration was 59.67 + 38.62 months.
Mostly SLE was established before pregnancy; about 10% SLE were firstly recognized during pregnancy.
During pregnancy, the disease activity was defined active in about two third (25 cases) of the patients. In most
cases (60%), disease activity was continued from the pre-pregnancy period. The most common manifestations
during pregnancy were lupus nephritis, hemolytic anemia, cutaneous rash, and arthritis respectively. In 40%
(10 patients), SLE was severely active but could be controlled with high doses of corticosteroid, two of these
required immunosuppressant.
Overall live-birth in SLE patients who delivered at Srinagarind Hospital was 72.7%. Among this
group, premature labor and intrauterine growth retardation were more commonly found in the patients who
had active SLE than who had disease remission throughout pregnancy period with ratio of 4:1 and 7:1
respectively. Pregnancy lost (27.3%) was due to abortion (6 cases) and dead fetus in utero (DFIU; 2 cases)
Termination of pregnancy was performed in 10 patients. Indications were severe active lupus (6
cases), DFIU (2 cases), and premature rupture of membrane (1 case). Pregnancy outcome was the best in
patients who had inactive disease throughout pregnancy (75%) and worse in groups of patients whose
disease flared up (54.5%) or emerged (50%) during pregnancy.
Conclusion: Even contraception was routinely advised in treating SLE patients, getting pregnant during
active disease was eventually found. Lupus nephritis was the most common manifestation. Overall live-birth
was 72.7%. Pregnancy lost was due to abortion and dead fetus in utero. Pregnancy outcome was worse in SLE
patients who had disease flares up or emerging during pregnancy.
Keywords: Fetal death, Fetal growth retardation, Infant, Newborn, Diseases, Lupus erythematosus, Systemic,
Postpartum period, Pre-eclampsia, Pregnancy, Pregnancy outcome
commonly occurs in childbearing age women. During pregnancy and postpartum period, disease activity may
be severe or unchanged. Disease flare during pregnancy consistently affects pregnancy outcome.
Objective: To study pregnancy outcomes and predictive factor for disease flare during pregnancy in SLE
patients.
Material and Method: Retrospective descriptive study was performed. The study population was pregnant
SLE patients who were treated between January 1997 and December 2006 at Department of Obstetrics-
Gynecologic and Medicine, Srinagarind Hospital, Khon Kaen University, Thailand.
Result: The medical records of 37 pregnant SLE patients were reviewed. Of these, 33 cases gave delivery at
Srinagarind Hospital. Mean age was 27.3 + 3.26 years, and mean disease duration was 59.67 + 38.62 months.
Mostly SLE was established before pregnancy; about 10% SLE were firstly recognized during pregnancy.
During pregnancy, the disease activity was defined active in about two third (25 cases) of the patients. In most
cases (60%), disease activity was continued from the pre-pregnancy period. The most common manifestations
during pregnancy were lupus nephritis, hemolytic anemia, cutaneous rash, and arthritis respectively. In 40%
(10 patients), SLE was severely active but could be controlled with high doses of corticosteroid, two of these
required immunosuppressant.
Overall live-birth in SLE patients who delivered at Srinagarind Hospital was 72.7%. Among this
group, premature labor and intrauterine growth retardation were more commonly found in the patients who
had active SLE than who had disease remission throughout pregnancy period with ratio of 4:1 and 7:1
respectively. Pregnancy lost (27.3%) was due to abortion (6 cases) and dead fetus in utero (DFIU; 2 cases)
Termination of pregnancy was performed in 10 patients. Indications were severe active lupus (6
cases), DFIU (2 cases), and premature rupture of membrane (1 case). Pregnancy outcome was the best in
patients who had inactive disease throughout pregnancy (75%) and worse in groups of patients whose
disease flared up (54.5%) or emerged (50%) during pregnancy.
Conclusion: Even contraception was routinely advised in treating SLE patients, getting pregnant during
active disease was eventually found. Lupus nephritis was the most common manifestation. Overall live-birth
was 72.7%. Pregnancy lost was due to abortion and dead fetus in utero. Pregnancy outcome was worse in SLE
patients who had disease flares up or emerging during pregnancy.
Keywords: Fetal death, Fetal growth retardation, Infant, Newborn, Diseases, Lupus erythematosus, Systemic,
Postpartum period, Pre-eclampsia, Pregnancy, Pregnancy outcome
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