Predicting Preterm Birth in Pregnancies of Women with Systemic Lupus Erythematosus

A study identified factors predictive of preterm birth in pregnant women with systemic lupus erythematosus (SLE), including a look at preconception care.

Although developments in treatments have resulted in more women with SLE becoming pregnant, they remain at an increased risk of poor outcomes, including miscarriage and preterm birth. Preconception is of significant importance, especially for women with preexisting conditions, but there are not a lot of data on preconception care for women with SLE.

The researchers retrospectively reviewed outcomes of 108 pregnancies in 74 women with SLE. Women with preterm birth and full-term birth were compared on the basis of pre-pregnancy clinical characteristics as well as disease activity.

Of the 108 pregnancies, there were 83 live births, 27 of which were preterm. The preterm birth group, compared to the full-term birth group, had significantly lower pre-pregnancy serum complement 3 (C3) level (77 mg/dl vs 87.5 mg/dl; P=0.029). Pre-pregnancy factors associated with pre-term birth upon multivariate analysis were history of lupus nephritis (odds ratio [OR], 5.734; 95% confidence interval [CI], 1.568-21.010; P=0.008) and C3 level <85 mg/dl (OR, 4.498; 95% CI, 1.296-15.616; P=0.018). Women with more risk factors were more likely to have a preterm birth. Among women with Systemic Lupus Erythematosus Disease Activity score ≤4, women with C3 <85 mg/dl pre-pregnancy had a higher preterm birth rate compared to those with C3 ≥85 mg/dl (42.1% vs 14.7%; P=0.018).

The study was published in Arthritis Research & Therapy.

The researchers wrote in their conclusion, “Prediction of preterm birth stratified by these risk factors will help rheumatologists and obstetricians who are struggling to manage pregnancies with SLE. In addition, this preconception care may increase the safety of the life events of pregnancy and childbirth, which have been a challenge for SLE patients. We hope that further research will enable SLE patients to become pregnant, give birth safely, and enrich their lives by spreading preconception care to all pregnant women with SLE.”