Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: A meta-analysis of studies published between years 2001-2016

Abstract

Background: Previous research has already shown systemic lupus erythematosus (SLE) to have severe consequences on pregnancy outcomes. However, insufficient number of participants, which were mainly limited to one particular region, limited outcomes analyzed and lack of evidence based analysis to support systematic reviews of the literature were the limitations observed. Therefore, by improving these limitations, we aimed to systematically show the impact of SLE on maternal and fetal outcomes following pregnancy.

Methods: The Cochrane Database of Randomized Controlled Trials, EMBASE and Medline databases were carefully searched for appropriately relevant English language studies comparing maternal and/or fetal outcomes (endpoints) in pregnant women with and without SLE. With the presence of discontinuous data, risk ratios (RR) and 95% confidence intervals (CI) were calculated and the final analysis was carried out by RevMan 5.3 software.

Results: Eleven studies with a total number of 529,778 participants were included. This current analysis showed cesarean operation to be significantly higher in patients with SLE (RR: 1.85, 95% CI: 1.63-2.10; P = 0.00001). Pre-eclampsia and hypertension also significantly affected women with SLE, (RR: 1.91, 95% CI: 1.44-2.53; P = 0.00001) and (RR: 1.99, 95% CI: 1.54-2.56; P = 0.00001) respectively. In addition, spontaneous abortion, thromboembolic disease, and post-partum infection were also significantly higher in the SLE subgroup (RR: 1.51, 95% CI: 1.26-1.82; P = 0.0001), (RR: 11.29, 95% CI: 6.05-21.07; P = 0.00001) and (RR: 4.35, 95% CI: 2.69-7.03; P = 0.00001) respectively. Live birth significantly favored infants who were born from mothers without SLE (RR: 1.38, 95% CI: 1.14-1.67; P = 0.001). Significantly higher premature birth and infants classified as 'small for gestational age' were associated with SLE, (RR: 3.05, 95% CI: 2.56-3.63; P = 0.00001) and (RR: 1.69, 95% CI: 1.53-1.88; P = 0.00001) respectively. In addition, SLE was significantly associated with increased number of infants that required neonatal intensive care unit and infants with congenital defects (RR: 2.76, 95% CI: 2.27-3.35; P = 0.00001) and (RR: 2.63, 95% CI: 1.93-3.58; P = 0.00001) respectively.

Conclusions: This meta-analysis has shown SLE to indeed have a high impact on maternal and fetal outcomes following pregnancy. Therefore, special treatments and care should be allocated to those women in order to manage adverse outcomes that might follow, and to improve successful normal delivery, term infants and to reduce congenital abnormalities in infants who were born from mothers with SLE.

Keywords: Fetal outcomes; Infant congenital defects; Maternal outcomes; Pregnancy; Premature infants; Spontaneous abortion; Systemic lupus erythematosus; Women.