Maternal outcome in pregnant women with lupus nephritis. A prospective multicenter study

Gabriella Moroni, Andrea Doria, Elisa Giglio, Enrico Imbasciati, Chiara Tani, Margherita Zen, Francesca Strigini, Barbara Zaina, Angela Tincani, Mariele Gatto, Federica de Liso, Claudia Grossi, Pier Luigi Meroni, Gianfranca Cabiddu, Piergiorgio Messa, Pietro Ravani, Marta Mosca

Research output: Contribution to journalArticle

Abstract

Retrospective studies reported a high incidence of maternal complications in pregnant women with lupus. In this paper we prospectively assessed the rate of risk and the risk factors of maternal outcome in women with stable lupus nephritis who received pre-pregnancy counseling.This prospective multicenter study includes 71 pregnancies in 61 women with lupus nephritis who became pregnant between 2006 and 2013. Complete renal remission was present before pregnancy in 56 cases (78.9%) and mild active nephritis in 15 cases. All women underwent a screening visit before pregnancy and were closely monitored by a multidisciplinary team. Lupus anticoagulant, serum C3 and C4 complement fractions, anti-DNA antibodies, anti-C1q antibodies, anticardiolipin IgG and IgM antibodies, anti-beta2 IgG and IgM antibodies were tested at screening visit, at first, second, third trimester of pregnancy, and one year after delivery. Renal flares of lupus during or after pregnancy, pre-eclampsia, and HELLP syndrome were defined as adverse maternal outcomes.Fourteen flares (19.7%), six cases of pre-eclampsia (8.4%) and two cases of HELLP (2.8%) occurred during the study period. All flares responded to therapy and the manifestations of pre-eclampsia and HELLP were promptly reversible. Low C3, high anti-DNA antibodies and predicted all renal flares. High anti-C1q antibodies and low C4 predicted early flares. The body mass index (BMI) was associated with increased risk of late flares. History of previous renal flares and the presence of clinically active lupus nephritis at conception did not increase the risk of renal flares during pregnancy. History of renal flares before pregnancy, arterial hypertension, and longer disease predicted pre-eclampsia/HELLP.In pregnant women with lupus nephritis adverse maternal outcomes were relatively common but proved to be reversible when promptly diagnosed and treated. Immunological activity, arterial hypertension and BMI may predispose to maternal complications.

Original languageEnglish
JournalJournal of Autoimmunity
DOIs
Publication statusAccepted/In press - May 11 2016

Fingerprint

Lupus Nephritis
Multicenter Studies
Pregnant Women
Mothers
Prospective Studies
Pregnancy
Pre-Eclampsia
Kidney
Antinuclear Antibodies
Anti-Idiotypic Antibodies
Body Mass Index
HELLP Syndrome
Hypertension
Complement C4
Lupus Coagulation Inhibitor
Complement C3
Antibodies
Nephritis
Third Pregnancy Trimester
Second Pregnancy Trimester

Keywords

  • Lupus nephritis
  • Preeclampsia
  • Pregnancy
  • Renal flares
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

Maternal outcome in pregnant women with lupus nephritis. A prospective multicenter study. / Moroni, Gabriella; Doria, Andrea; Giglio, Elisa; Imbasciati, Enrico; Tani, Chiara; Zen, Margherita; Strigini, Francesca; Zaina, Barbara; Tincani, Angela; Gatto, Mariele; de Liso, Federica; Grossi, Claudia; Meroni, Pier Luigi; Cabiddu, Gianfranca; Messa, Piergiorgio; Ravani, Pietro; Mosca, Marta.

In: Journal of Autoimmunity, 11.05.2016.

Research output: Contribution to journalArticle

Moroni, Gabriella ; Doria, Andrea ; Giglio, Elisa ; Imbasciati, Enrico ; Tani, Chiara ; Zen, Margherita ; Strigini, Francesca ; Zaina, Barbara ; Tincani, Angela ; Gatto, Mariele ; de Liso, Federica ; Grossi, Claudia ; Meroni, Pier Luigi ; Cabiddu, Gianfranca ; Messa, Piergiorgio ; Ravani, Pietro ; Mosca, Marta. / Maternal outcome in pregnant women with lupus nephritis. A prospective multicenter study. In: Journal of Autoimmunity. 2016.
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abstract = "Retrospective studies reported a high incidence of maternal complications in pregnant women with lupus. In this paper we prospectively assessed the rate of risk and the risk factors of maternal outcome in women with stable lupus nephritis who received pre-pregnancy counseling.This prospective multicenter study includes 71 pregnancies in 61 women with lupus nephritis who became pregnant between 2006 and 2013. Complete renal remission was present before pregnancy in 56 cases (78.9{\%}) and mild active nephritis in 15 cases. All women underwent a screening visit before pregnancy and were closely monitored by a multidisciplinary team. Lupus anticoagulant, serum C3 and C4 complement fractions, anti-DNA antibodies, anti-C1q antibodies, anticardiolipin IgG and IgM antibodies, anti-beta2 IgG and IgM antibodies were tested at screening visit, at first, second, third trimester of pregnancy, and one year after delivery. Renal flares of lupus during or after pregnancy, pre-eclampsia, and HELLP syndrome were defined as adverse maternal outcomes.Fourteen flares (19.7{\%}), six cases of pre-eclampsia (8.4{\%}) and two cases of HELLP (2.8{\%}) occurred during the study period. All flares responded to therapy and the manifestations of pre-eclampsia and HELLP were promptly reversible. Low C3, high anti-DNA antibodies and predicted all renal flares. High anti-C1q antibodies and low C4 predicted early flares. The body mass index (BMI) was associated with increased risk of late flares. History of previous renal flares and the presence of clinically active lupus nephritis at conception did not increase the risk of renal flares during pregnancy. History of renal flares before pregnancy, arterial hypertension, and longer disease predicted pre-eclampsia/HELLP.In pregnant women with lupus nephritis adverse maternal outcomes were relatively common but proved to be reversible when promptly diagnosed and treated. Immunological activity, arterial hypertension and BMI may predispose to maternal complications.",
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AU - Zen, Margherita

AU - Strigini, Francesca

AU - Zaina, Barbara

AU - Tincani, Angela

AU - Gatto, Mariele

AU - de Liso, Federica

AU - Grossi, Claudia

AU - Meroni, Pier Luigi

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