Preeclampsia in pregnancies complicated by systemic lupus erythematosus (SLE) nephritis: prophylactic treatment with multidisciplinary approach are important keys to prevent adverse obstetric outcomes.
INTRODUCTION
Systemic lupus erythematosus (SLE) commonly affects women of childbearing age. Hypertension, antiphospholipid syndrome, and lupus nephritis are risk factors for adverse maternal/fetal outcome. The aim of this retrospective cohort study is to compare pregnancy outcomes in patients with and without SLE nephritis, using a multidisciplinary approach and a broad prophylaxis protocol.


MATERIALS AND METHODS
Data were collected from 86 pregnancies complicated by SLE. Twenty-seven women with nephropathy before pregnancy stated as the study group and 59 formed the control group. Each group received a prophylactic treatment based on their clinical characteristics. Results were expressed as mean ± SD, percentage and χ2-test (significant values when p < .05).


RESULTS
The prophylactic treatment (60.4% of the patients) significantly controlled the complications related to some risk factors, such as antiphospholipid antibodies (aPL) and nephritis. Preeclampsia occurred in 14.8% of patients. Patients with pregestational hypertension showed a 2.75 odds ratio of adverse events when compared to the group without chronic hypertension. The presence of proteinuria was associated with a risk of preeclampsia 2.45 times greater, as well as serum creatinine >1.2 mg/dL, which was related to a risk 1.25 times higher than the risk observed in patients with serum creatinine <1.2 mg/dL. A 6-month inactive disease was associated with a better outcome. A value of Estimated Glomerular Filtration Rate (eGFR) < 90 mL/min/1.73 m2 resulted in a 18.73 times greater risk of preeclampsia, intrauterine growth restriction (IUGR), and preterm delivery.


DISCUSSION
A multidisciplinary approach in a tertiary care center and a broad prophylactic treatment protocol to patients affected by SLE and complicated by nephritis may definitively foster a successful pregnancy.
['Mecacci|Federico|F|', 'Simeone|Serena|S|', 'Cirami|Calogero Lino|CL|', 'Cozzolino|Mauro|M|http://orcid.org/0000-0002-5929-2357', 'Serena|Caterina|C|', 'Rambaldi|Marianna Pina|MP|', 'Gallo|Pamela|P|', 'Emmi|Lorenzo|L|', 'Cammelli|Daniele|D|', 'Mello|Giorgio|G|', 'Matucci Cerinic|Marco|M|']
D000328:Adult D017152:Antibodies, Antiphospholipid D001241:Aspirin D016022:Case-Control Studies D003404:Creatinine D005260:Female D005343:Fibrinolytic Agents D006495:Heparin, Low-Molecular-Weight D006801:Humans D008181:Lupus Nephritis D011225:Pre-Eclampsia D011247:Pregnancy D011256:Pregnancy Outcome D012189:Retrospective Studies D012307:Risk Factors D016216:Ultrasonography, Prenatal D055988:Uterine Artery
Preeclampsia systemic lupus erythematosus SLE nephritis prophylaxis protocol