Pregnant Systemic Lupus Patients: Impact of Bad Prognostic Factors on Disease Flare

Background Patients with systemic lupus erythematosus experience a heightened incidence of adverse pregnancy outcomes for both mother and fetus, with reports documenting increased rates of spontaneous abortion, fetal loss, intra-uterine growth retardation, pre-term delivery, pregnancy-induced hypertension, pre-eclampsia, and disease flares. Objective To evaluate the SLE-disease activity score (SLE-DAS) in the first trimester as a predictor for maternal flares in the second and third trimesters, along with Adverse Pregnancy Outcomes (APO) in pregnant women with SLE. Patients and methods: This covert study was done on 50 SLE patients. Disease activity and Maternal flares were assessed by applying SLE-DAS at first, second and third trimester; subdivided into mild/moderate and severe. Follow up: Visits were scheduled every trimester and post-partum to detect fetal outcomes. Results 24% of patients had at least one APO, 41 patients (82.0%) had live birth, 36% developed APO, 16% of them were preterm birth due to placental insufficiency, 16% developed IUFD ≥ 12 weeks, and 4% had small for gestational age infants. Regarding maternal outcomes 22% of patients developed disease flare-up during pregnancy. We found significantly younger age at pregnancy and higher disease activity in the first trimester among flare group in 2nd and 3rd trimester than non-flare group (p = 0.023, 0.000 respectively). Conclusion In the first trimester, lupus patients showed a significant association between APO and increased disease activity; thus, adequately managing disease activity leads to better pregnancy outcomes.