Systemic lupus erythematosus in pregnancy: experience from a tertiary care center in Northeast India

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that most commonly affects women in the reproductive age group. Although pregnancy is allowed with low disease activity, individuals diagnosed with SLE have a higher risk of complications from pregnancy (for both the mother as well as the fetus) than the general population. Such risks may include spontaneous abortions, intrauterine fetal demise, preeclampsia, eclampsia, intrauterine growth restriction (IUGR), and preterm delivery. Pregnant women who have active disease at conception or during early pregnancy, have lupus nephritis in the past, or have antiphospholipid syndrome are at increased risk of obstetrical complications. This retrospective study was carried out at All India Institute of Medical Sciences, Guwahati (Northeast India). This case series includes 3 pregnant patients with SLE as reviewed in the study for maternal and fetal outcomes.

In two patients in our case series, caesarean section was provided one for failed induction and another for a non-reassuring non-stress test. Both infants were normal at birth without any cardiovascular anomaly and were sent for neonatal evaluation for neonatal lupus, which was normal. The third patient required medical termination of pregnancy at 25 weeks of gestation in view of worsening maternal condition. Anticoagulants, steroids and immunosuppressants also pose high risks for the mother and the unborn child. The best approach to management will have to be multidisciplinary with medical, obstetric, and neonatal supervision in order to achieve a good prognosis.