Multidisciplinary Care Improves Outcomes in High-Risk SLE Pregnancies

The use of a multidisciplinary care pathway for pregnant women with systemic lupus erythematosus (SLE) who had previous adverse obstetric outcomes may lead to improved pregnancy outcomes, including a high live birth rate, according to study results published in Clinical Rheumatology.

Researchers conducted a prospective cohort study to assess the effects of a predefined, multidisciplinary care, pathway-based management program on pregnancy outcomes among patients with SLE who previously had adverse obstetric outcomes. They prospectively screened all consecutive patients with SLE who had at least 1 previous adverse outcome (maternal or fetal) between March 2010 and March 2023.

The multidisciplinary care management pathway comprised drug and disease activity counseling before conception and postnatally, along with periodic visits throughout pregnancy and postnatally for continued drug and disease activity status review. Included patients were also given access to a nurse-led telephone helpline and received care input from a diverse team of clinicians.

Among the 197 women enrolled in the study, the mean patient age was 28 years and the average SLE duration before conception was 5.82 years. Overall, the included patients had 226 pregnancies over the span of 13 years, of which 10% were achieved through assisted reproductive techniques due to secondary infertility. Only 4 twin pregnancies were reported.

The previous adverse outcomes included 186 miscarriages and 51 instances of preterm labor. Despite 25% of women having anti-Ro/La antibodies, no prior history of fetal heart block was reported, although 11 infants had a neonatal lupus rash; 19% of patients had a history of lupus nephritis but were currently in remission.  

While the live birth rate was high (86%), 18% of the infants had low birth weight. Caesarean sections were common, accounting for 45% of deliveries.

Mild lupus flares occurred frequently, while moderate flares were observed among 9% of pregnancies and severe flares among 3.5%.

Disease activity was generally mild during both the preconception and postpartum periods, with disease activity index scores reflecting mild or no activity, except during flares.

Overall, there were 30 miscarriages and 2 intrauterine fetal deaths, with the latter associated with new-onset lupus nephritis; the majority of miscarriages (n=24/30) were not related to high disease activity or lupus flares.

Study limitations include a lack of perinatal data and detailed reasons for caesarean sections.

The researchers concluded, “Improved access to rheumatology services and collaboration between rheumatologists and obstetricians is key to improving outcomes in SLE pregnancies.”

This article originally appeared on Rheumatology Advisor