Adverse Impact of Systemic Lupus Erythematosus on Pregnancy Outcomes: A Saudi Arabia Retrospective Multi-Center Study

Figures & data

Table 1 Baseline and Clinical Characteristics of Patients with Systemic Lupus (n=66)

Study Variables	N (%)
Age at pregnancy in years (mean ± SD)	35.0 ± 4.98
Age of disease onset in years (mean ± SD)	26.2 ± 4.73
Duration of disease in years (mean ± SD)	6.79 ± 4.88
Hypothyroidism	14 (21.2%)
Post Kidney transplant	01 (01.5%)
Sjogren’s syndrome	01 (01.5%)
Prednisolone used before pregnancy	40 (60.6%)
Prednisolone used during pregnancy	45 (68.2%)
B2GP1	09 (13.6%)
Lupus anticoagulation	01 (01.5%)
aCL	07 (10.6%)
Anti-DNA	25 (37.9%)
SSA	24 (36.4%)
SSB	10 (15.2%)
SLEDAI-2k activity before pregnancy
Inactive	51 (77.3%)
Active	15 (22.7%)
Planned pregnancy
Planned	56 (84.8%)
Not planned	10 (15.2%)
Patient activated during pregnancy	04 (04.6%)
DMARDs used during pregnancy	60 (90.9%)
HCQ	57 (86.4%)
Azathioprine	18 (27.3%)
Tacrolimus	02 (03.0%)
Cyclosporine	01 (01.5%)
Hemoglobin (mean ± SD)	12.0 ± 1.24
Platelet (mean ± SD)	285.7 ± 80.6
WBC (mean ± SD)	5.80 ± 2.08
C3 (mean ± SD)	0.96 ± 0.30
C4 (mean ± SD)	0.19 ± 0.10

Table 2 Comparison Between Pregnancy SLE Group and Healthy Control Group

Factor	SLE Cases N (%) (n=66)	Healthy Control N (%) (n=93)	P-value ^§
Age in years (mean ± SD)	35.4 ± 5.37	30.5 ± 7.71	<0.001 ** ^‡
Delivery mode
Vaginal	38 (58.5%)	87 (93.5%)	<0.001 **
Cesarean	27 (41.5%)	06 (06.5%)
Neonatal outcome
Newborn weight in kg (mean ± SD)	2.30 ± 1.06	3.07 ± 0.45	<0.001 ** ^‡
Congenital anomalies	04 (06.1%)	01 (01.1%)	0.161
Stillbirth	02 (03.0%)	01 (01.1%)	0.570
Miscarriage	11 (16.7%)	05 (05.4%)	0.030 **
NICU	05 (07.6%)	01 (01.1%)	0.083
Preterm	10 (15.2%)	05 (05.4%)	0.053
Preeclampsia	05 (07.6%)	01 (01.1%)	0.083
Live birth	53 (80.3%)	87 (93.5%)	0.014 **

Notes: ^§P-value has been calculated using Fischer Exact test. ^‡P-value has been calculated using an independent sample t-test. **Significant at p<0.05 level.

Table 3 Relationship Between Clinical Variables and SLE Pregnancy-Related Outcome (n=66)

Factor	Adverse Pregnancy Outcome		P-value ^§
	Yes N (%) (n=35)	No N (%) (n=31)
Disease duration in years (mean ± SD)	6.49 ± 5.12	7.13 ± 4.65	0.597 ^‡
Age at pregnancy in years (mean ± SD)	33.9 ± 4.72	32.1 ± 5.18	0.146 ^‡
SLE manifestation	10 (28.6%)	06 (19.4%)	0.383
Hypothyroidism	09 (25.7%)	05 (16.1%)	0.382
Current active lupus nephritis	06 (17.1%)	0	0.026 **
History of lupus nephritis	09 (25.7%)	05 (16.1%)	0.342
SLEDAI-2k activity before pregnancy
Inactive	23 (65.7%)	28 (90.3%)	0.017 **
Active	12 (34.3%)	03 (09.7%)
SLEDAI-2k activity during pregnancy
Inactive	27 (77.1%)	27 (87.1%)	0.352
Active	08 (22.9%)	04 (12.9%)
Planned pregnancy
Planned	28 (80.0%)	28 (90.3%)	0.314
Not planned	07 (20.0%)	03 (09.7%)
Prednisolone used before pregnancy
No	14 (40.0%)	13 (41.9%)	1.000
Yes	21 (60.0%)	18 (58.1%)
Prednisolone used during pregnancy
No	10 (28.6%)	11 (35.5%)	0.547
Yes	25 (71.4%)	20 (64.5%)
DMARDs medication history before pregnancy
Azathioprine	07 (20.0%)	08 (25.8%)	0.769
Methotrexate	01 (02.9%)	01 (03.2%)	1.000
MMF	02 (06.7%)	03 (09.7%)	1.000
Cyclophosphamide	0	01 (03.2%)	0.470
Rituximab	02 (05.7%)	03 (09.7%)	0.659
Belimumab	0	01 (03.2%)	0.470
DMARDs medication at least 6 months before and during pregnancy
Azathioprine	10 (28.6%)	08 (25.8%)	1.000
Tacrolimus	02 (05.7%)	0	0.494
Cyclosporine	01 (02.9%)	0	1.000
Hemoglobin before pregnancy
<10	01 (02.9%)	01 (03.2%)	0.900
10–12	16 (45.7%)	16 (51.6%)
>12	18 (51.4%)	14 (45.2%)
Hemoglobin after pregnancy
<10	08 (22.9%)	01 (03.2%)	0.074
10–12	14 (40.0%)	16 (51.6%)
>12	13 (37.1%)	14 (45.2%)
WBC before pregnancy
<4	08 (22.9%)	05 (16.1%)	0.549
≥4	27 (77.1%)	26 (83.9%)
WBC after pregnancy
<4	05 (14.3%)	03 (09.7%)	0.713
≥4	30 (85.7%)	28 (90.3%)
C3 before pregnancy
<0.80 g/dl	10 (28.6%)	08 (25.8%)	1.000
≥0.80 g/dl	25 (71.4%)	23 (74.2%)
C4 before pregnancy
<0.12 g/dl	10 (28.6%)	05 (16.1%)	0.256
≥0.12 g/dl	25 (71.4%)	26 (83.9%)
C3 after pregnancy
<0.80 g/dl	13 (37.1%)	07 (22.6%)	0.284
≥0.80 g/dl	22 (62.9%)	24 (77.4%)
C4 after pregnancy
<0.12 g/dl	11 (31.4%)	06 (19.4%)	0.398
≥0.12 g/dl	24 (68.6%)	25 (80.6%)
24-hour protein before pregnancy
<0.5 g/dl	30 (85.7%)	30 (96.8%)	0.202
≥0.5 g/dl	05 (14.3%)	01 (03.2%)
24-hour protein after pregnancy
<0.5 g/dl	29 (82.9%)	30 (96.8%)	0.110
≥0.5 g/dl	06 (17.1%)	01 (03.2%)
ESR before pregnancy (mean ± SD)	30.4 ± 19.1	22.6 ± 13.9	0.094 ^‡
CRP before pregnancy (mean ± SD)	6.76 ± 7.08	4.71 ± 4.18	0.238 ^‡
ESR after pregnancy (mean ± SD)	28.7 ± 24.3	35.1 ± 24.8	0.408 ^‡
CRP after pregnancy (mean ± SD)	11.1 ± 19.6	7.01 ± 10.9	0.414 ^‡
Anti-DNA N (%)	13 (37.1%)	12 (38.7%)	1.000
aCL N (%)	04 (11.4%)	03 (09.7%)	1.000
Lupus Anticoagulation N (%)	01 (02.9%)	0	1.000
Anti SSA N (%)	12 (34.3%)	12 (38.7%)	0.709
Anti SSB N (%)	06 (17.1%)	04 (12.9%)	0.739
Anti SSA/Anti SSB N (%)	04 (11.4%)	04 (12.9%)	1.000

Notes: ^§P-value has been calculated using the Fischer Exact test. ^‡P-value has been calculated using an independent sample t-test. **Significant at p<0.05 level.

Table 4 Multivariate Regression Analysis for the Independent Significant Predictor of SLE Adverse Pregnancy-Related Outcome (n=66)

Factor	UOR	95% CI	P-value
SLEDAI-2k activity before pregnancy
Inactive ≤ 4	Ref
Active >4	4.870	1.225–19.359	0.025 **

Notes: **Significant at p<0.05 level.

Abbreviations: UOR, Unadjusted Odds Ratio; CI, Confidence Interval.

Figure 1 Trend of SLEDAI-2k disease activity before pregnancy to 9 months of follow-up.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.