Pregnancy outcome in Nigerians with systemic lupus erythematosus: case series and literature review

Abstract

Background: Pregnancy has been reported to constitute a high risk in lupus patients. However, with the emergence of potent disease modifying antirheumatic drugs (DMARDs), pregnancy outcome has become more favorable in this group of patients. There is thus a need to report the Nigerian experience so as to add to the body of knowledge. There has been no report on pregnancy outcome among Nigerian lupus patients. Objective: To describe the maternal and fetal outcomes among pregnant female systemic lupus erythematosus [SLE] patients attending Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria. Methods: A retrospective case series of pregnancy outcome in systemic lupus erythematosus (SLE) patients between the years 2011 to 2015. Data about demography, symptoms during pregnancy, blood pressure, investigations, treatment, route of delivery and pregnancy outcome were collected from patients' case record files. Data was analyzed using descriptive statistics. Results: The outcome of 15 pregnancies in 12 lupus patients were reported. The outcome of the pregnancies were eight live births from elective cesarean section (CS), three live births via spontaneous vaginal delivery, a stillborn following vaginal delivery, an intrauterine fetal death from intrauterine growth restriction, a spontaneous abortion, and a maternal mortality. Mean birth weight was 2.8kg (SD+/-0.5). Active disease and hypertension were observed in 2 pregnancies each, while lupus nephritis was present in 5 pregnancies. Only one of the patients was hospitalized before delivery due to a flare of lupus nephritis. Antiphospholipid syndrome occurred in 1 of the pregnancies. There was no occurrence of a flare post-delivery, neither was there any case of neonatal lupus syndrome nor congenital heart block.