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Editorials |4 August 2015

Pregnancy in Women With Systemic Lupus Erythematosus: Messages for the Clinician

Bevra H. Hahn, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published online first at www.annals.org on 23 June 2015.
  • From David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1301.

    Requests for Single Reprints: Bevra H. Hahn, MD, Distinguished Professor of Medicine (Emeritus), Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, Room 31-75, 1000 Veteran Avenue, Los Angeles, CA 90095.

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In this issue, Buyon and colleagues (1) report findings from the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study, a large prospective study of pregnancy outcomes in women with systemic lupus erythematosus (SLE). The study involved 8 centers in the United States and 1 in Canada serving patients of diverse socioeconomic status and ethnicity. The restrictions for study entry are important to note. Patients were required to have reached at least 12 weeks of a singleton gestation; have inactive SLE or mild to moderate SLE activity; be free of heavy proteinuria, microscopic hematuria, and abnormal serum creatinine levels; not be receiving a prednisone dose greater than 20 mg/d; and be free of diabetes and uncontrolled hypertension. However, despite the limited study population, the article contains valuable information for clinicians who have the joy and challenge of participating in the medical management of these women.
First, the good news. Among the women studied, pregnancy outcomes were good in 81%, meaning that the infant was born alive, survived the neonatal period, was delivered after at least 36 weeks' gestation, and was in at least the fifth percentile for birthweight. This is similar to the outcome in another recent North American cohort (2). Furthermore, the PROMISSE study identified characteristics of U.S. women who had optimal outcomes. A successful pregnancy outcome was achieved by 92% of non-Hispanic white women with negative lupus anticoagulant test results, no treatment for hypertension, no or low disease...
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Hahn BH. Pregnancy in Women With Systemic Lupus Erythematosus: Messages for the Clinician. Ann Intern Med. 2015;163:232–233. doi: 10.7326/M15-1301

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Published: Ann Intern Med. 2015;163(3):232-233.

DOI: 10.7326/M15-1301

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