Risk Factors For Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus: A Meta Analysis and Systemic review

Background: Systemic lupus erythematosus (SLE) is a prominent autoimmune disease highly linked to adverse pregnancy outcomes (APOs). Previous research on the risk factors for APOs in SLE pregnancies has been limited by regional constraints or inadequate sample sizes. There is currently a dearth of comprehensive systemic reviews on this topic. To address these research gaps, we conducted a rigorous meta-analysis and systematic review to elucidate the risk factors for APOs in SLE pregnancies. Methods: PubMed, Embase, Web of Science, and the Cochrane Library systematically searched for articles on risk factors for APOs in SLE pregnancy from initiation to December 31, 2023. The pooled Odds Ratio (OR) was estimated using a random-effects or fixed-effects model for each investigated factor. Egger's P value was calculated to assess publication bias and heterogeneity was evaluated by the I ² test. Results: 42 unique studies were enrolled. Patients with hypertension (OR, 5.23; 95% CI, 2.76–9.91), lupus nephritis (LN) (OR, 3.02; 95% CI, 2.10–4.34), high disease activity (OR, 2.51; 95% CI, 1.39–4.50), low complements (OR, 1.94; 95% CI, 1.39–2.72), antiphospholipid syndrome (APS)/positive antiphospholipid antibody (aPL) (OR, 7.93; 95% CI, 4.35–14.44) were at higher risk for APOs. The risk factors for preterm birth included LN (OR, 3.69; 95% CI, 2.31–5.89), hypertension (OR, 4.50; 95% CI, 1.86–10.87), disease flares (OR, 4.02; 95% CI, 2.24–7.19), disease activity (OR, 3.92; 95% CI, 2.52–6.10), preeclampsia/eclampsia (OR, 8.85;95% CI, 4.72–16.58), and APS (OR, 3.95; 95% CI, 2.20–7.07). The risk factors for pregnancy loss were APS/aPL (OR, 3.46; 95% CI, 2.44–4.91), low complements (OR, 2.60; 95% CI, 1.08–6.27), disease flares (OR, 2.72; 95% CI, 1.36–5.46), LN (OR, 3.47; 95% CI, 1.74–6.89), hypertension (OR, 1.33; 95% CI, 0.71–1.94), thrombocytopenia (OR, 8.85; 95% CI, 4.72–16.58), and disease activity (OR, 9.19; 95% CI). LN also predicted intrauterine growth restriction (OR, 3.51; 95% CI, 1.30–9.51) and low birth weight (OR, 5.55; 95% CI, 1.29–23.86). Conclusions: This study identified risk factors for APOs in SLE pregnancies, enhancing clinician awareness and enabling early intervention for high-risk patients.