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Background and Aims

Women with SLE face a high risk of preeclampsia (PE). Therefore, low dose Aspirin (LDA) is recommended for SLE pregnancies to protect against PE. Lately, a beneficial effect of hydroxychloroquine (HCQ) has been discussed. We aimed to investigate the influence of LDA and HCQ on the occurrence of PE in SLE.

Methods

SLE pregnancies from an outpatient pregnancy clinic were prospectively evaluated. Association of timely LDA or HCQ use with PE was analysed using a multiple logistic regression model.

Results

We enrolled 190 pregnancies. Additional risk factors for PE were present in 83.7%: high-risk profile (HRP) in 55.8% (history of PE, hypertension, lupus nephritis, aPL), moderate risk factor in 27.9% (nulliparous, BMI>30, age>35). Each 20.5% of pregnancies received HCQ or LDA only, while 22.6% were prescribed both. Women with HRP were more likely to take LDA alone or in combination with HCQ (28.3% and 35.8%, respectively).

PE occurred in 13.2% (7.7% HCQ only, 15.4% LDA only, 14.0% HCQ and LDA, 14.5% no HCQ or LDA). Most pregnancies affected carried a HRP (88.0%).

Use of LDA was significantly associated with a lower risk for PE [aOR 0.21 (95%-CI 0.05-0.99), p<0.05]. HCQ use also had a moderating effect [aOR 0.47 (95%-CI 0.15-1.52), p=0.21]. If only pregnancies with HRP were considered, the effect size increased for HCQ [aOR 0.28 (95%-CI 0.07-1.14), p=0.075].

Conclusions

In this real-life cohort, a favourable effect on the occurrence of PE was partially explained by HCQ. In particular, SLE patients at high risk for PE seem to benefit from HCQ during pregnancy.

Background and Aims

Belimumab (BEL) is an anti-BLyS monoclonal antibody approved for SLE treatment. Few data are available on its administration before or during pregnancy. The aim of this study is to describe pregnancies in SLE patients who have discontinued BEL either at preconception or at positive pregnancy test or during pregnancy.

Methods

Data of SLE prospectively-followed pregnancies (2014-2020) in SLE patients treated with BEL in 3 Italian centers where retrospectively collected, focusing on disease activity and pregnancy outcome. The use of BEL during pregnancy was agreed with the patient during the preconception counseling.

Results

Fourteen SLE pregnancies were analyzed (mean age at conception 32.9±5.4 years; 79% spontaneous, 71% primigravidae; 79% planned). BEL (12 intravenous, 2 subcutaneous) was stopped in 2 cases preconceptionally, in 8 at positive pregnancy test and in 4 during pregnancy (2 at 11^th week, 1 at 22^nd, 1 at 24^th) (Table 1). Other treatments during pregnancy were: prednisone (13); antimalarials (12); azathioprine (6); calcineurin-inhibitors (5); low-dose acetylsalicylic acid (11); low molecular weight heparin (9).

At preconception visit, the mean SLEDAI was 2.9±2.6.

Three flares occurred in the 3^rd trimester, all in patients who suspended BEL at positive pregnancy test.

Live-births were 93%; 1 late miscarriage occurred. One eclampsia (hesitated in perinatal death) and 1 pre-eclampsia occurred.

No malformations were recorded. Two newborns were hospitalized in Intensive Care Unit (milk protein intolerance; desaturation).

Conclusions

This small series suggests that BEL might be an option for SLE patients planning a pregnancy (as other biological drugs in different rheumatologic diseases), although more data are needed.

Background and Aims

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 1^st trimester is associated or not with subsequent flares and adverse pregnancy outcome (APO) and which factors determined physician’s opinion.

Methods

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 (<3^rd percentile).

Results

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), 1^st 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).

Conclusions

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.