Fetal outcome of lupus pregnancy: a retrospective case-control study of the Hopkins Lupus Cohort.

OBJECTIVE

To determine the frequency of pregnancy loss, preterm birth, and therapeutic abortion in patients with systemic lupus erythematosus (SLE) versus controls.

METHOD

The outcome of lupus pregnancy was determined in the largest retrospective case-control study to date, involving 203 patients with SLE with 481 pregnancies, 166 "best friends" with 356 pregnancies and 177 relatives with 566 pregnancies.

RESULTS

Pregnancy loss (spontaneous abortion, miscarriage, or stillbirth) was more common in lupus pregnancies (21%) than in pregnancies in friends (14%, p = 0.01) or in relatives (8%, p < or = 0.0001) and was more common after the diagnosis of SLE than before (27 19%, p = 0.04). Preterm birth (< or = 36 weeks) was more common in lupus pregnancies (12%) than in pregnancies in friends (4%, p < or = 0.0001) or in relatives (4%, p < or = 0.0001) and was more common after the diagnosis of SLE than before (24 vs 6%, p < or = 0.0001). Preterm birth in lupus pregnancies after the diagnosis of SLE was associated with nonhigh school graduates (p = 0.001), Raynaud's phenomenon (p = 0.007), and hypertension requiring treatment (p = 0.01).

CONCLUSION

We conclude that both pregnancy loss and preterm birth are significantly increased in lupus pregnancy versus control pregnancy and that these pregnancy outcomes are more common after the diagnosis of SLE.