Maternal and fetal outcomes in pregnant patients with lupus nephritis

Duminda B. Basnayake, Abdul W. M. Wazil, Nishantha Nanayakkara, Ayesha Nayanamali, Ruwina A. Deepani, Inoka Chathurani, Kushan T. Thennakoon, Naduni H. Erandika, Buddhika Wijayawickrama, Dulani K. Devagiri


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

Methods: In a single-center, 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. A 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, pre-eclampsia in 3) at a 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 2.62 kg (SD=0.5) and in pre-term babies, it was 1.85 kg. Sixteen caesarian sections were performed in term deliveries, three as emergencies. 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 with 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

Conclusions: Pregnancy induced hypertension is a more commonly encountered complication in pregnancies with lupus nephritis. The fetal outcome is unfavorable in pregnancies with renal flares.



Lupus nephritis, Pregnancy, Maternal outcomes, Fetal outcomes, Sri Lanka

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