Pregnancy outcome in lupus nephropathy

The maternal and fetal outcomes of 55 pregnancies in 24 patients with pre-existing lupus nephritis (LN) were retrospectively analysed. The risk factors for poor fetal outcome were evaluated. The patients were divided into two groups. Patients in Group A had quiescent LN and those in Group B showed clinical evidence of active LN at conception. In Group A, of the 36 pregnancies in 16 patients, 11 resulted in term deliveries without complications, 9 in spontaneous abortions, 6 in preterm deliveries, 3 in intrauterine growth retardation (IUGR) and in 2 stillbirths. In Group B, of the 19 pregnancies in 8 patients, there were 6 spontaneous abortions, 3 uncomplicated term deliveries and 10 pregnancies were complicated by hypertension. Gross IUGR occurred in 3 pregnancies. There were 3 stillbirths and 1 neonatal death in the study. Total fetal loss was 38.2% and the perinatal mortality (PNM) rate, 150/1,000 deliveries. Two mothers, both from Group B died in the series, 1 from multisystem failure of systemic lupus erythematosus, 3 days after delivery and the second died from irreversible renal failure 2 months after caesarean section. Pregnant women with long-standing LN are at high risk of spontaneous abortions and increased PNM. However, the outlook of pregnancy in patients with stable LN at conception is relatively favourable. The risk of obstetric complications and maternal mortality is high in patients with active lupus nephropathy associated with pre-existing hypertension. Pregnant women with LN require intense fetal and maternal surveillance for the best outcomes of pregnancy.