The impact of different classes of lupus nephritis on maternal and fetal outcomes: a cohort study of 147 pregnancies

Autor:	Roger A. Levy, G Ramires de Jesus, B Costa Rodrigues, E Mendes Klumb, N. Ramires de Jesus, Flávia Cunha dos Santos, M Ignacchiti Lacerda
Rok vydání:	2019
Předmět:	Adult medicine.medical_specialty Adverse outcomes Perinatal Death Lupus nephritis Cohort Studies Hospitals University 03 medical and health sciences Young Adult 0302 clinical medicine Rheumatology Pre-Eclampsia Pregnancy medicine Humans 030212 general & internal medicine skin and connective tissue diseases 030203 arthritis & rheumatology Fetus Systemic lupus erythematosus Obstetrics business.industry Cesarean Section Infant Newborn Pregnancy Outcome medicine.disease Lupus Nephritis Hospitalization Pregnancy Complications Cohort Intensive Care Neonatal Female business Nephritis Brazil Infant Premature Cohort study
Zdroj:	Lupus. 28(4)
ISSN:	1477-0962
Popis:	Objective To analyze the impact of different classes of lupus nephritis as risk variables for maternal and fetal adverse outcomes in a cohort of pregnant lupus patients. Methods This is a cohort study with retrospective and prospective data collection, conducted at the University Hospital of State University of Rio de Janeiro, Brazil, from 2011 to 2016. A total of 147 pregnancies of 137 systemic lupus erythematosus patients of whom 66 had lupus nephritis were included. Demographic and clinical features, as well as maternal and fetal outcomes were observed for each nephritis histological class among systemic lupus erythematosus patients and compared with those without nephritis. Categorical variables were expressed as absolute and relative frequencies and numerical variables as means and standard deviation. The chi-square test with Fisher's correction and Student's t-test were used for statistical analysis. A pvalue Results Systemic lupus erythematosus patients with proliferative nephritis (classes III/IV, n = 54) presented more frequent disease flares ( p = 0.02), continuous active disease during pregnancy and puerperium ( p = 0.006), hospitalization due to systemic lupus erythematosus ( p Conclusion Systemic lupus erythematosus patients with proliferative nephritis (classes III/IV) have a higher frequency of adverse maternal outcomes. This is probably due to the major impact of proliferative forms of nephritis on women's global heath, which is corroborated by the higher Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index findings, although we cannot exclude the negative influence of disease activity for the maternal adverse events. The findings indicate a need for further lupus nephritis classification beyond the nonspecific term nephritis in the context of lupus pregnancy as the impact on maternal and fetal outcomes varies according to histological class.
Databáze:	OpenAIRE
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