Adequate preconception counseling and risk stratification is important to improve pregnancy outcome in systemic lupus erythematosus (SLE) but little is known on factors associated with physician’s opinion in allowing or not pregnancy. We analyzed whether physician’s opinion at 1st trimester is associated or not with subsequent flares and adverse pregnancy outcome (APO) and which factors determined physician’s opinion.
We analysed SLE women included in the GR2 prospective multicentric study with an ongoing singleton pregnancy at 12weeks (one pregnancy/woman). Physician’s opinion included allowed (“green light”), intermediate (“orange light”) and not recommended (“red light”) pregnancy. APO included fetal/neonatal death, placental insufficiency with delivery<37 weeks, and small-for-gestational-age (<3rd percentile).
Among 238 pregnancies (98.3% on hydroxychloroquine which ended with 230 live-births) at least one flare occurred in 35 (14.7%) and an APO in 34 (14.3%).
150 women (64.6%) had had a preconception counseling visit (n=232). Physicians’ opinion (n=234) was “green” (n=202; 86.3%), “orange” (n=24; 10.3%), and “red light” (n=8; 3.4%). The “green light” was inversely associated with APOs (p<0.001) but not with subsequent flares (p=0.59).
Predictive factors of “green light” were clinical quiescent disease before pregnancy (p=0.04), previous preconception counseling visit (p=0.01), 1st trimester clinical SLEPDAI=0 (p=0.02), SLICC-damage index=0 (p=0.03), absence of lupus anticoagulant (p=0.003), continuous maternal age (p=0.04).
The favorable physician’s opinion was inversely associated with APO but not with flares. Its predictors were preconception counseling, clinical quiescent disease before conception, the absence of lupus anticoagulant, clinical activity and damage in the first trimester, and older maternal age.