Pregnancy outcome in juvenile systemic lupus erythematosus: A Brazilian multicenter cohort study
Autor(a) principal: | |
---|---|
Data de Publicação: | 2008 |
Outros Autores: | , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://hdl.handle.net/11449/219463 |
Resumo: | Objective. To determine pregnancy outcome and fetal loss risk factors in patients with juvenile systemic lupus erythematosus (JSLE). Methods. A total of 315 female patients with JSLE followed in 12 Brazilian pediatric rheumatology centers were consecutively selected. Menarche was observed in 298 (94.6%) patients. Patients' medical records were reviewed for pregnancy outcomes and demographic, clinical, and therapeutic data. Results. A total of 24 unplanned pregnancies occurred in 298 (8%) patients. The outcomes were 5 (21%) early fetal losses (prior to 16 wks gestation), 18 (75%) live births, and 1 (4%) death due to preeclampsia and premature birth. The frequencies of active diffuse proliferative glomerulonephritis, proteinuria ≥ 0.5 g/day, and arterial hypertension at the beginning of pregnancy were higher in pregnancies resulting in fetal losses than in live births [60% vs 5% (p = 0.02), 60% vs 5% (p = 0.02). 60% vs 5% (p = 0.02), respectively]. JSLE pregnancies with fetal losses had a significantly higher mean SLE Disease Activity Index 2000 (SLEDAI-2K) at the start of pregnancy compared with those with live births (9.40 ± 7.47 vs 3.94 ± 6.00; p = 0.049). Four pregnancies were inadvertently exposed to intravenous cyclophosphamide therapy for renal involvement despite contraceptive prescriptions, resulting in fetal loss in 3 (p = 0.02). In multivariate analysis only intravenous cyclophosphamide use at start of pregnancy (OR 25.50, 95% CI 1.72-377.93, p = 0.019) remained as an independent risk factor for fetal loss. Conclusion. We identified immunosuppressive therapy as the major contributing factor for fetal loss in JSLE, reinforcing the importance of contraception. |
id |
UNSP_c3b4829e92554aac485679053472824d |
---|---|
oai_identifier_str |
oai:repositorio.unesp.br:11449/219463 |
network_acronym_str |
UNSP |
network_name_str |
Repositório Institucional da UNESP |
repository_id_str |
2946 |
spelling |
Pregnancy outcome in juvenile systemic lupus erythematosus: A Brazilian multicenter cohort studyAdolescentCyclophosphamideFetal lossOutcomePregnancySystemic lupus erythematosusObjective. To determine pregnancy outcome and fetal loss risk factors in patients with juvenile systemic lupus erythematosus (JSLE). Methods. A total of 315 female patients with JSLE followed in 12 Brazilian pediatric rheumatology centers were consecutively selected. Menarche was observed in 298 (94.6%) patients. Patients' medical records were reviewed for pregnancy outcomes and demographic, clinical, and therapeutic data. Results. A total of 24 unplanned pregnancies occurred in 298 (8%) patients. The outcomes were 5 (21%) early fetal losses (prior to 16 wks gestation), 18 (75%) live births, and 1 (4%) death due to preeclampsia and premature birth. The frequencies of active diffuse proliferative glomerulonephritis, proteinuria ≥ 0.5 g/day, and arterial hypertension at the beginning of pregnancy were higher in pregnancies resulting in fetal losses than in live births [60% vs 5% (p = 0.02), 60% vs 5% (p = 0.02). 60% vs 5% (p = 0.02), respectively]. JSLE pregnancies with fetal losses had a significantly higher mean SLE Disease Activity Index 2000 (SLEDAI-2K) at the start of pregnancy compared with those with live births (9.40 ± 7.47 vs 3.94 ± 6.00; p = 0.049). Four pregnancies were inadvertently exposed to intravenous cyclophosphamide therapy for renal involvement despite contraceptive prescriptions, resulting in fetal loss in 3 (p = 0.02). In multivariate analysis only intravenous cyclophosphamide use at start of pregnancy (OR 25.50, 95% CI 1.72-377.93, p = 0.019) remained as an independent risk factor for fetal loss. Conclusion. We identified immunosuppressive therapy as the major contributing factor for fetal loss in JSLE, reinforcing the importance of contraception.Paediatric Rheumatology Unit University of São PauloPaediatric Rheumatology Unit Federal University of São PauloPaediatric Rheumatology Unit Federal University of Rio de JaneiroPaediatric Rheumatology Unit Santa Casa of São PauloPaediatric Rheumatology Unit State University of Rio de JaneiroPaediatric Rheumatology Unit State University of CampinasPaediatric Rheumatology Unit Santa Casa of Belo HorizonteDivision of Rheumatology Federal University of Rio de JaneiroDivision of Rheumatology University of São PauloUniversity of São Paulo-Ribeirão PretoHospital São Rafael-BahiaState University of São Paulo-BotucatuUniversidade de São Paulo (USP)Federal University of Rio de JaneiroSanta Casa of São PauloState University of Rio de JaneiroUniversidade Estadual de Campinas (UNICAMP)Santa Casa of Belo HorizonteHospital São Rafael-BahiaSilva, Clovis A. A.Hilario, Maria O.Febronio, Marilia V.Oliveira, Sheila K.Almeida, Rozana G.Fonseca, Adriana R.Yamashita, Edson M.Ronchezel, Marcos V.Campos, Luciene L.Appenzeller, SimoneQuintero, Maria V.Santos, Ana B.Medeiros, Ana C.Carvalho, Luciana M.Robazzi, Teresa C.Cardin, Silvana P.Bonfa, Eloisa2022-04-28T18:55:44Z2022-04-28T18:55:44Z2008-07-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article1414-1418Journal of Rheumatology, v. 35, n. 7, p. 1414-1418, 2008.0315-162Xhttp://hdl.handle.net/11449/2194632-s2.0-47349087020Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengJournal of Rheumatologyinfo:eu-repo/semantics/openAccess2022-04-28T18:55:44Zoai:repositorio.unesp.br:11449/219463Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462022-04-28T18:55:44Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Pregnancy outcome in juvenile systemic lupus erythematosus: A Brazilian multicenter cohort study |
title |
Pregnancy outcome in juvenile systemic lupus erythematosus: A Brazilian multicenter cohort study |
spellingShingle |
Pregnancy outcome in juvenile systemic lupus erythematosus: A Brazilian multicenter cohort study Silva, Clovis A. A. Adolescent Cyclophosphamide Fetal loss Outcome Pregnancy Systemic lupus erythematosus |
title_short |
Pregnancy outcome in juvenile systemic lupus erythematosus: A Brazilian multicenter cohort study |
title_full |
Pregnancy outcome in juvenile systemic lupus erythematosus: A Brazilian multicenter cohort study |
title_fullStr |
Pregnancy outcome in juvenile systemic lupus erythematosus: A Brazilian multicenter cohort study |
title_full_unstemmed |
Pregnancy outcome in juvenile systemic lupus erythematosus: A Brazilian multicenter cohort study |
title_sort |
Pregnancy outcome in juvenile systemic lupus erythematosus: A Brazilian multicenter cohort study |
author |
Silva, Clovis A. A. |
author_facet |
Silva, Clovis A. A. Hilario, Maria O. Febronio, Marilia V. Oliveira, Sheila K. Almeida, Rozana G. Fonseca, Adriana R. Yamashita, Edson M. Ronchezel, Marcos V. Campos, Luciene L. Appenzeller, Simone Quintero, Maria V. Santos, Ana B. Medeiros, Ana C. Carvalho, Luciana M. Robazzi, Teresa C. Cardin, Silvana P. Bonfa, Eloisa |
author_role |
author |
author2 |
Hilario, Maria O. Febronio, Marilia V. Oliveira, Sheila K. Almeida, Rozana G. Fonseca, Adriana R. Yamashita, Edson M. Ronchezel, Marcos V. Campos, Luciene L. Appenzeller, Simone Quintero, Maria V. Santos, Ana B. Medeiros, Ana C. Carvalho, Luciana M. Robazzi, Teresa C. Cardin, Silvana P. Bonfa, Eloisa |
author2_role |
author author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade de São Paulo (USP) Federal University of Rio de Janeiro Santa Casa of São Paulo State University of Rio de Janeiro Universidade Estadual de Campinas (UNICAMP) Santa Casa of Belo Horizonte Hospital São Rafael-Bahia |
dc.contributor.author.fl_str_mv |
Silva, Clovis A. A. Hilario, Maria O. Febronio, Marilia V. Oliveira, Sheila K. Almeida, Rozana G. Fonseca, Adriana R. Yamashita, Edson M. Ronchezel, Marcos V. Campos, Luciene L. Appenzeller, Simone Quintero, Maria V. Santos, Ana B. Medeiros, Ana C. Carvalho, Luciana M. Robazzi, Teresa C. Cardin, Silvana P. Bonfa, Eloisa |
dc.subject.por.fl_str_mv |
Adolescent Cyclophosphamide Fetal loss Outcome Pregnancy Systemic lupus erythematosus |
topic |
Adolescent Cyclophosphamide Fetal loss Outcome Pregnancy Systemic lupus erythematosus |
description |
Objective. To determine pregnancy outcome and fetal loss risk factors in patients with juvenile systemic lupus erythematosus (JSLE). Methods. A total of 315 female patients with JSLE followed in 12 Brazilian pediatric rheumatology centers were consecutively selected. Menarche was observed in 298 (94.6%) patients. Patients' medical records were reviewed for pregnancy outcomes and demographic, clinical, and therapeutic data. Results. A total of 24 unplanned pregnancies occurred in 298 (8%) patients. The outcomes were 5 (21%) early fetal losses (prior to 16 wks gestation), 18 (75%) live births, and 1 (4%) death due to preeclampsia and premature birth. The frequencies of active diffuse proliferative glomerulonephritis, proteinuria ≥ 0.5 g/day, and arterial hypertension at the beginning of pregnancy were higher in pregnancies resulting in fetal losses than in live births [60% vs 5% (p = 0.02), 60% vs 5% (p = 0.02). 60% vs 5% (p = 0.02), respectively]. JSLE pregnancies with fetal losses had a significantly higher mean SLE Disease Activity Index 2000 (SLEDAI-2K) at the start of pregnancy compared with those with live births (9.40 ± 7.47 vs 3.94 ± 6.00; p = 0.049). Four pregnancies were inadvertently exposed to intravenous cyclophosphamide therapy for renal involvement despite contraceptive prescriptions, resulting in fetal loss in 3 (p = 0.02). In multivariate analysis only intravenous cyclophosphamide use at start of pregnancy (OR 25.50, 95% CI 1.72-377.93, p = 0.019) remained as an independent risk factor for fetal loss. Conclusion. We identified immunosuppressive therapy as the major contributing factor for fetal loss in JSLE, reinforcing the importance of contraception. |
publishDate |
2008 |
dc.date.none.fl_str_mv |
2008-07-01 2022-04-28T18:55:44Z 2022-04-28T18:55:44Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
Journal of Rheumatology, v. 35, n. 7, p. 1414-1418, 2008. 0315-162X http://hdl.handle.net/11449/219463 2-s2.0-47349087020 |
identifier_str_mv |
Journal of Rheumatology, v. 35, n. 7, p. 1414-1418, 2008. 0315-162X 2-s2.0-47349087020 |
url |
http://hdl.handle.net/11449/219463 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Journal of Rheumatology |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
1414-1418 |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
_version_ |
1799964577213972480 |