Women with Lupus who Become Pregnant During Low Disease Activity are Unlikely to Experience Flares throughout Pregnancy and Post-Partum
Women with inactive or mild lupus disease activity at the time of conception typically experience mild flares during and after pregnancy and at similar rates, according to a new study. Moreover, a woman’s age and clinical and blood activity at start of pregnancy can also be used to predict flare activity during pregnancy.
A group of 384 women participating in the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study, a prospective, multiethnic, multiracial cohort of women with lupus were monitored. Flare activity during the pregnancy of each group member was assessed. Post-partum flares were assessed in 234 group participants who were visited 2-6 months after their baby was born. Of the entire group, 26% experienced a flare at any point in their pregnancy, 20.8% experienced at least one mild flare and 6.25% had at least one severe flare. The majority of all flares occurred in the second and third trimesters, with only 4% occurring in the first trimester.
Women likely to flare during pregnancy were characterized by higher disease activity at conception, non-white race, younger age, and low blood complement (C4) levels. However, even in women with risk factors, rates of flares were low. Medications were not associated with flare activity, including hydroxychloroquine (Plaquenil®), although 60% of the women in the group were taking the drug throughout their pregnancy.
Post-partum, mild flares were documented in 22.7% of women and severe flares in 1.7%, similar to the rates observed during pregnancy. Flares were distributed throughout the post-partum period: 22.8% after 2 months, 45.6% after 3 months, 21.1% after 4 months, and 10.5% after 5 months. No predictors of flares post-partum were identified, including having had a flare during pregnancy. Investigators did not find increased rate of lupus flares between 2 - 6 months post-partum compared to that during pregnancy with an overall flare rate of 24.4%.
Women with lupus are at increased risk for poor fetal and maternal outcomes. This study helps to better understand the rate and characteristics of post-partum flares and identify possible flare predictors during pregnancy and post-partum. The researchers believe the results can reassure women that if they plan their pregnancy at a time of low disease activity, they are unlikely to experience flares during or in the six months after pregnancy. Learn more about planning a pregnancy when you have lupus.