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ACR Special Report: Chicago, IL 2011

Women with Lupus Can Have a Safe Pregnancy and Healthy Baby

One of the most devastating effects of lupus is that it often affects women during their childbearing years. For years, doctors warned women with lupus to avoid pregnancy, citing high rates of complications during pregnancy and delivery, as well as risks to the baby. But the results of a major study presented at the ACR found that women whose disease is stable—even those with lupus nephritis—can have a healthy pregnancy, delivery, and baby.

The Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus (PROMISS) is designed to find ways to predict the likelihood of problems in women with lupus who become pregnant. Researchers, including ALR grantees Jill Buyon, MD of New York University Medical Center and Jane Salmon, MD, of the Hospital for Special Surgery in New York City, are following 4 groups of women: those with lupus, those with lupus and antiphospholipid syndrome, those with antiphospholipid syndrome only, and healthy women who have already had at least 1 healthy pregnancy and delivery.

The study presented at ACR was based on 333 pregnancies. Most of the women with lupus had markers of serious disease, including a history of lupus nephritis, the presence of anti-DNA autoantibodies, antiphospholipid antibodies, and/or low complement levels.

Overall, researchers reported, about 19% of the women with lupus experienced some type of complication during their pregnancy or delivery compared to 5% of healthy women. However, the complication rate in the general population is about 10%, and other studies have reported complication rates in women with lupus as high as 30%. Those studies, however, had a broader definition of “complications” than this one, Dr. Buyon noted. In this study, complications were defined as miscarriage, stillborn birth, early delivery (before 36 weeks), newborns who were small for their gestational age, and preeclampsia in the mother.

The “extraordinary news,” said Dr. Buyon during a press conference about the study, is that just 15 patients (4%) had a severe flare during their pregnancy, while just 18% experienced a mild-to-moderate flare. Few of the women required steroids during their flares.

Women who had slightly higher disease activity when they got pregnant; anticoagulant antibodies; slightly higher uric acid in the second and third trimesters; and a smaller complement increase as the pregnancy progressed were most likely to develop complications, as were women with a past history of kidney disease.

“What the study says is that even patients with a history of lupus nephritis can do well during pregnancy,” Dr. Buyon said, if they wait to become pregnant until their disease is stable and are closely managed by obstetrical specialists.x

Key point: It is possible to have a healthy pregnancy and a healthy baby if you work closely with your doctor on the timing of pregnancy and are closely monitored throughout pregnancy.

More information about lupus and treatment advances can be found by visiting www.lupusresearch.org.

The Alliance for Lupus Research Special Report on the 2011 American College of Rheumatology Meeting was made possible in part by generous support from Genentech.

©2011 Alliance for Lupus Research. All Rights Reserved.

Contents herein may not be reproduced, republished or distributed without the prior written permission of the Alliance for Lupus Research. To request permission to reproduce, republish or distribute any part of this report, contact us at 212-218-2840 or email info@lupusresearch.org.

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