Pregnancy and Lupus Nephritis: A Review
BACKGROUND: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder often affecting women of reproductive age, whose fertility is typically unaltered by their disease. SLE - and lupus nephritis (LN) in particular - has a significant impact on the course of pregnancy, as well as the outcomes for mother and fetus. Ideally patients have been in remission for a minimum of 6 months prior to conception. LN in pregnancy increases the patient's risk of SLE flare, as well poor outcomes including fetal loss, pre-eclampsia, and maternal death. Good outcomes are achievable for these patients, and have been well documented in the developed world, but less is known about patients in developing nations. METHODS: A literature review was performed of the available literature in regards to lupus nephritis and pregnancy in developing nations. Few studies were available, primarily retrospective case series. A review of these studies was performed, and analyzed for trends in regards to the impact of active disease at conception or lupus nephritis on flare rates, live birth rates, and fetal loss rates. The studies were also examined for any notable geographic trends. RESULTS: Based on the studies reviewed, there is a trend observed between active disease at conception and a lower rate of live birth. A trend was observed between high rates of LN and higher rates of flare, which many studies reported as being statistically significant. A relationship between high rates of LN and higher rates of fetal loss was also observed. With regards to geographic trends, lower overall live birth rates and higher rates of active disease at conception were noted in Indian studies. Interestingly, lower rates of pre-eclampsia were also noted in the Indian studies. Higher rates of flare were observed in the Asian studies. CONCLUSION: Good outcomes are possible for patients with lupus nephritis seeking pregnancy, even in low resource settings. More research is necessary to fully understand the relationships between active disease at conception or lupus nephritis on flare rates, live birth rates, and fetal loss rates.