Maternal and fetal outcomes in pregnant patients with lupus nephritis

Basnayake BMDB1, Wazil AWM1, Nanayakkara N1, Deepani AAR1, Chathurani MMI1, Thennakoon TDK1, Wijayawickrama BA1, Nayanamali MAA1, Devagiri DMSDK1

1Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka

Background: Pregnancy in a woman with lupus nephritis (LN) carries a high risk of maternal and fetal morbidity and mortality. Aim of this study is to analyze the effect of LN on maternal and fetal outcomes and lupus activity.

Method: In a single centre, cross sectional observational study at national hospital Kandy, 32 pregnancies in 23 women with biopsy proven LN between 2007 and 2019 were analyzed retrospectively.

Results: Mean age at pregnancy was 28.4 years (SD=4.8, range 19–38 years). In six women, LN developed during pregnancy, 17 patients were already diagnosed with LN when they became pregnant. Renal biopsy performed 4.6 (SD=3.8) years before pregnancy showed diffuse LN in 18 (78.3%) and focal LN in 5 (21.7%) cases. At conception most patients were in complete (43.8%) or partial (21.9%) remission.

Therapeutic abortion was performed in 8 pregnancies (indications: renal flares in 5, pregnancy induced hypertension (PIH) in 3) at mean period of amenorrhea (POA) of 16.8 weeks (range 8-28 weeks). Spontaneous fetal loss occurred in one pregnancy. Among 23 live births, there were four pre-term deliveries (< 36 weeks gestation) and 19 term deliveries. In term deliveries mean birth weight was 2.62kg (SD=0.5) and in pre-term babies it was 1.85kg.  Sixteen caesarian sections were performed in term deliveries, three as emergency. All the pre-term babies were delivered by emergency caesarian sections. There was no statistically significant relationship (p>0.05) between LN histological type, initial clinical presentation and treated hypertension, and fetal outcome. No case of neonatal lupus or congenital heart block was noted.

During pregnancy, there were five (15.6%) renal flares and two acute kidney injury cases; all were reversible. Eight patients (25%) developed PIH.

 Conclusion: Pregnancy induced hypertension is more commonly encountered complication in pregnancies with lupus nephritis. Fetal outcome is unfavorable in pregnancies with renal flares.

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