Pregnancy outcome in women with systemic lupus erythematosus treated with immunosuppressive drugs

• Published in: Journal of rheumatology Vol. 20; no. 7; p. 1152
• Main Authors: Ramsey-Goldman, R, Mientus, J M, Kutzer, J E, Mulvihill, J J, Medsger, Jr, T A
• Format: Journal Article
• Language: English
• Published: Canada 01-07-1993
• Subjects: Abortion, Spontaneous - epidemiology; Adolescent; Adult; Azathioprine - adverse effects; Azathioprine - therapeutic use; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Female; Fetal Death - epidemiology; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Incidence; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - epidemiology; Methotrexate - adverse effects; Methotrexate - therapeutic use; Middle Aged; Obstetric Labor, Premature - epidemiology; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Outcome; Retrospective Studies
• ISSN: 0315-162X

The aim of this retrospective study was to assess the impact of immunosuppressive drugs (ISD) on pregnancy outcome in women with systemic lupus erythematosus (SLE).
Pregnancy outcome, disease manifestations, and medication use were ascertained by interview and review of the medical record. Three hundred thirty-four (88%) of 380 consecutive women with lupus seen during 1979-1989 at the Lupus Diagnostic and Treatment Center at the University of Pittsburgh participated in this study.
Adverse pregnancy outcomes were noted in 59 of 113 (52%) pregnancies in patients with pregnancies after diagnosis of SLE and no exposure to ISD (Group 1) and in 10 of 23 (43%) pregnancies in patients with pregnancies after diagnosis of SLE and with ISD use prior to or during pregnancy (Group 2). Only 3 of 23 or 13% pregnancies in Group 2 resulted in a fetal or neonatal loss compared to 27% in Group 1 (NS). No history of malignancy has been noted in the longterm followup of the surviving children in Group 2 (current mean age is 6.1 years, range 1.5-13 years).
Although overall survival was encouraging in Group 2, questions remain about the safety and longterm mutagenic effects of ISD in women with SLE. Judicious use of these medications prior to or during pregnancy is warranted.