Some Women with Lupus Can Bear Children Safely

Certain women whose lupus is inactive are able to have safe births, according to a study done by researchers at Hospital for Special Surgery.

Women whose lupus is inactive and who don’t have certain risk factors can have healthy pregnancies and give birth safely, a study led by researchers at Hospital for Special Surgery (HSS) has found. The study published June 23 in the Annals of Internal Medicine was launched in 2003 to identify risk factors for poor pregnancy outcomes in women with lupus and antiphospholipid antibody syndrome.

Lupus primarily affects women of childbearing age, so doctors have long advised women who suffer from it to avoid pregnancy because of potential risks to their health and their baby’s health. Although the cause is not known, the disease disproportionately affects African-American, Hispanics, Asian Americans and Native Americans, who are likely to have more severe forms of the disease and more complications. Black women are three times more likely to have it than White women are, according to the Office on Women’s Health in the U.S. Department of Health and Human Services.
Systemic lupus erythematosus, commonly known as lupus, is an autoimmune disease in which the body’s immune system mistakenly attacks and damages healthy tissue. It can affect the skin, joints, kidneys, brain and other organs. Dr. Jane E. Salmon, director of the Lupus and APS Center of Excellence and Collette Kean Research Chair at Hospital for Special Surgery, the principal investigator of the study, said the findings “provide a clear direction for counseling patients and reassuring women with inactive lupus.”

However, she said, “We also learned that patients with specific clinical features and certain antibodies that can be detected early in pregnancy by blood tests have an increased risk of serious pregnancy complications.”
Researchers followed 385 pregnant women seen monthly by study investigators between September 2003 and December 2012 at eight sites in the United States and one in Canada in a multiethnic, multiracial study that constituted the largest prospective study of lupus pregnancies.

All women were enrolled in the first 12 weeks of their pregnancies and had inactive or stable mild to moderate lupus disease activity at the time of enrollment.

According to the Annals of Internal Medicine, women with very active lupus, and those who were taking more than 20 milligrams of prednisone per day were not allowed to participate in the study. The study also excluded women with diabetes or high blood pressure.

The findings are from study known as PROMISSE (Predictors of pRegnancy Outcome: bioMarkers In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus) funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.

Investigators reported that

  • 81 percent of pregnancies were free of complications
  • 5 percent of pregnancies resulted in fetal or neonatal death
  • 9 percent of women had a preterm delivery
  • 10 percent of babies had a low birth weight
  • Most patients with the pregnancy complications had one or more risk factors: a specific antiphospholipid
    antibody in the blood, a history of hypertension, and/or a low platelet count.

“It was exciting to see that severe lupus flares occurred in less than 3 percent of women during pregnancy,” said Salmon. “Lupus patients and their doctors can be confident of a good pregnancy outcome in most cases if lupus is quiescent when they become pregnant. Our findings now allow clinicians to identify the patients at high risk and manage them accordingly.”

Premium Employers