10-year study finds pregnancy safe for most lupus patients

Newly published results of a 10-year study on lupus patients has found that women can expect a good pregnancy outcome if their disease is inactive, and they are found to be free of certain risk factors.

Lupus is an autoimmune disease in which the body’s immune system mistakenly attacks and damages healthy tissue. It primarily affects women of childbearing age, and can surface in the skin, joints, kidneys, brain and other organs. It was once advised that women diagnosed with lupus not become pregnant because of possible risks to their health and baby.

Now, however, researchers at the Hospital for Special Surgery (HSS) who published the Predictors of Pregnancy Outcome: biomarkers In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus (PROMISSE), have data to refute that.

The PROMISSE study followed 385 pregnant women with mild-to-moderate lupus disease from 2003 to 2012. The women were multi-ethnic from the United States and Canada. Overall, 81 percent of the pregnancies were found to be free of complications, with just 5 percent ending in fetal or neonatal death. Nine percent of women had preterm delivery, while 10 percent of babies had low birth weight.

Researchers found that patients who suffered pregnancy complications also had one or more risk factors such as a specific antiphosolipid antibody in the blood, a history of hypertension or low platelet count. Further, the study found that patients could continue to take low doses of prednisone, the most commonly prescribed steroid for lupus, throughout the pregnancy.

Dr. Jane E. Salmon, lead researcher and director of the Lupus and APS Center of Excellence and Collette Kean Research Chair at the Hospital for Special Surgery in New York City said the results provide a clear direction for how physicians should counsel their patients.

“When your disease is stable, with very mild activity, you won’t get into trouble,” Salmon said. “One should counsel patients that even if you have had kidney disease, if you want until things are in a good place, and you are doing relatively well on low doses of immunosuppressant therapy, you can have an uncomplicated pregnancy.”

Salmon said the team also discovered 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.