Early SLE flares tied to poor pregnancy outcomes: fewer live births and term deliveries seen: first and second trimesters.(News)

ORLANDO, FLA. -- Severe systemic lupus erythematosus flares during the first and second trimesters led to a markedly reduced rate of live births and a drop in term deliveries in a study involving more than 200 women, Dr. Michelle Petri said at the annual meeting of the American College of Rheumatology.

Such findings suggest that women with systemic lupus erythematosus (SLE) who become pregnant may need more intensive monitoring and control of their disease activity during the first and second trimesters, which represents a break from current practice, in which monitoring tends to be most intense in the third trimester, said Dr. Petri, professor of medicine at Johns Hopkins University, Baltimore. The lead investigator for this study was Dr. Megan E.B. Clowse, who works with Dr. Petri.

The study reviewed all pregnant women who were patients at the Lupus Center at Johns Hopkins Hospital during 1986-2002. Each time these women were seen by physicians at the center, their disease severity was assessed by the physicians on a scale of zero (no activity) to three (severe activity). For this analysis, visits assessed as zero or one were considered low activity, and visits rated as two or three were considered high activity.

The 266 pregnancies included in the analysis involved 202 women; 18% had been diagnosed with SLE within the past year (including women who were first diagnosed during pregnancy), 37% had been diagnosed 1-5 years previously, and 45% had been diagnosed more than 5 years previously. High SLE activity was identified in at least one assessment in 56 of the pregnancies. For ...