Pregnancy outcome in connective tissue diseases

OBJECTIVE: To describe the pregnancy outcome in women with systemic lupus erythematosus and other connective tissue diseases attending a specialized high risk clinic at the Royal London Hospital.

METHODS: Retrospective review of 30 patients seen over a 30-month period. Diagnoses included 18 patients with lupus and 5 with mixed connective tissue disease. Patients were evaluated following a standardized protocol.

RESULTS: For all patients there were 28 (93%) live births and 2 spontaneous abortions. Of the live births, 6 (21%) were preterms and 5 (17%) were small for gestational age. For the 18-lupus patients there were 17 (94%) live births and one spontaneous abortion. Of the live births, 3 (18%) were preterm, 25% were small for gestational age and one had neonatal lupus erythematosus. Nine patients (30%) were positive for anti Sjogren's syndrome A antibodies: 7 systemic lupus erythematosus patients (39%) and 2 mixed connective tissue disease patients. Eight patients were positive for anti-phospholipid antibodies: 5 for anti-cardiolipin and 3 patients for lupus anticoagulant.

CONCLUSION: Most pregnancies complicated by lupus do well with no maternal or neonatal deaths in a multidisciplinary high-risk clinic. However a high rate of prematurity and small gestational age remains a problem.