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Systemic lupus erythematosus (SLE) affects, particularly, women of childbearing age. Global SLE survival improvement due to better therapeutic management would lead to authorisation of pregnancy in an increased number of women. Pregnancy associated with lupus, especially lupus nephritis, is often fraught with concern for both the mother and fetus.
This retrospective analysis examines 13 pregnancies in 7 women diagnosed with histologically confirmed lupus nephritis between 2011 and 2022. Demographic data encompassed the age at the initial pregnancy post-diagnosis, duration from lupus nephritis diagnosis to conception, and pre-conceptional clinical parameters such as blood pressure, degree of proteinuria, and kidney function were recorded. Medication regimens during pregnancy were documented, and pregnancy-related complications, including hypertension, preeclampsia, and renal function changes, were analysed. Neonatal outcomes, specifically birth weight and signs of neonatal lupus, were assessed.
The mean age at the time of the first pregnancy post-diagnosis of lupus nephritis was 27 years, with a range from 23 to 37 years. All seven women had biopsy-confirmed proliferative lupus nephritis classified as either Class III or IV. Two of patients were positive for anti-beta2 glycoprotein and anticardiolipin antibodies. The average duration from the initial diagnosis of lupus nephritis to the first pregnancy was about 3.8 years. All patients were normotensive and had normal kidney function prior to conception. During the pregnancies, they were prescribed with prednisolone (100%), 85% on Hydroxychloroquine, and 42% on Azathioprine.
Notably, only one patient who had advanced chronic changes in her kidney biopsy (class IV - 69% global sclerosis with moderate chronic tubulointerstitial damage) with significant proteinuria > 1g/day developed preeclampsia at 35 weeks of gestation, necessitating an emergency lower caesarean section, resulting in a low birth weight of 1.8kg. Of the 13 pregnancies, nine required emergency lower caesarean sections, primarily due to fetal distress (six cases), failed induction of labor (two cases), and preeclampsia (one case). The mean fetal birth weight was 2.43 kg (range: 1.8 kg to 3.25 kg). All newborns were vigilantly monitored for signs of neonatal lupus post-delivery, with no reported cases observed.
Post-partum follow-up revealed no instances of worsening renal function among the patients. The study underscores the possibility of successful pregnancies in women with lupus and prior lupus nephritis. However, achieving favorable outcomes hinges on meticulous planning and collaborative care among obstetricians, nephrologists, and rheumatologists. While occurrences of renal function decline and adverse fetal outcomes were rare, continuous monitoring remains indispensable, particularly in high-risk scenarios.