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The Outcome of Pregnancy in Women with Lupus Nephritis

Renal Unit, Guy's Campus, UMDS, London, UK

Jackie Hicks

Renal Unit, Guy's Campus, UMDS, London, UK

J. Stewart Cameron

Renal Unit, Guy's Campus, UMDS, London, UK

We analysed the outcome of pregnancy in patients with pre-existing lupus nephritis, seen in a tertiary referral centre for nephrology. Fifty-three pregnancies in 25 patients who already had clinical and histological evidence of lupus nephritis were recorded between January 1970 and June 1989, and data were analysed retrospectively. All 53 pregnancies occurred in patients with more or less stable disease, while three pregnancies during which lupus first presented were excluded. Six pregnancies were ended by therapeutic abortions (four for social reasons), and in eight spontaneous abortion occurred. Thus, 39 deliveries occurred, 28 at 36 weeks or more, while 11 were delivered prematurely, of which one was a stillbirth. After allowance was made for therapeutic abortions, the fetal loss rate (9/47) was 19%. Seventeen Caesarian sections were performed in the 39 completed pregnancies (44%), 11 as emergencies. Although the overall fetal loss, incidence of premature births and Caesarian section rate were all higher than expected for a population of normal women, neither initial histology, treated hypertension, the presence of proteinuria or a nephrotic syndrome showed statistically significant relationships with the outcome of completed pregnancies. In no case was maternal renal function affected irreversibly, although proteinuria increased substantially during pregnancy in six patients, and creatinine clearance fell during pregnancy, also in six patients. No 'flares' in systemic disease were seen, but all patients save five were treated with a brief period of high-dose oral corticosteroids or intravenous methylprednisolone in the postpartum period. No case of neonatal lupus or congenital heart block was observed. Pregnancy in patients with stable lupus nephritis established on treatment usually has a good outcome, even in the presence of initially severe disease, persisting treated hypertension, and continued immunosuppression with prednisolone and azathioprine, although a higher fetal loss is observed. The outcome for patients with lupus and even severe nephritis is no worse than that previously reported in women with lupus without nephritis.

Key Words: Systemic lupus erythematosus • Pregnancy • Glomerulonephritis • Immunosuppressive agents

Lupus, Vol. 1, No. 1, 19-25 (1991)
DOI: 10.1177/096120339100100104


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