Study finds most women with lupus can have good pregnancies, identifies risk factors

Newly published results of a 10-year study on lupus patients has found that women can expect a good pregnancy outcome if their disease is inactive and they are found to be free of certain risk factors. Researchers at the Hospital for Special Surgery (HSS) published the results of their study, called Predictors of Pregnancy Outcome: biomarkers In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus (PROMISSE), on Monday.

Lupus is an autoimmune disease in which the body’s immune system mistakenly attacks and damages healthy tissue. It primarily affects women of childbearing age and can affect the skin, joints, kidneys, brain and other organs. It was once advised that women diagnosed with lupus not become pregnant because of possible risks to their health and baby.

The PROMISSE study followed 385 pregnant women with mild to moderate lupus disease from 2003 until 2012. The women were multi-ethnic and from the United States and Canada. Overall, 81 percent of the pregnancies were found to be free of complications, with just five percent ending in fetal or neonatal death. Nine percent of women had a preterm delivery, while ten percent of babies had a low birth weight.

Researchers found that patients who suffered pregnancy complications also had one or more risk factors such as a specific antiphosolipid antibody in the blood, a history of hypertension, or a low platelet count.

“Our findings provide a clear direction for counseling patients, and reassuring women with inactive lupus,” Dr. Jane E. Salmon, lead researcher and director of the Lupus and APS Center of Excellence and Collette Kean Research Chair at the Hospital for Special Surgery in New York City, said. “We also learned that patients with specific clinical features and certain antibodies that can be detected early in pregnancy by blood tests, have an increased risk of serious pregnancy complications.”

Patients whose disease had stabilized or gone into remission were able to continue taking low doses of prednisone, which was found to be safe during pregnancy. Salmon said that potential disease flare ups would be more harmful for pregnant patients, compared to taking a low dose of the medication, the most commonly prescribed steroid for lupus, which works to decrease swelling, tenderness and pain associated with inflammation .

About 30 percent of the lupus patients enrolled in the study had a history of kidney disease. According to Salmon, as long as lupus was quiescent and being controlled with a low dose of medication, pregnancy did not further harm the organs.

“When your disease is stable, with very mild activity, you won’t get into trouble,” Salmon told “It won’t go into more remission, but you’ll stay without organ damage.”

“One should counsel patients that even if you have had kidney disease, if you wait until things are in a good place, and you are doing relatively well on low doses of an immunosuppressant therapy, you can have an uncomplicated pregnancy,” Salmon said.

Going forward, researchers believe their findings may help them to develop a way to identify high risk lupus patients who may be potential candidates for interventional trials.

Lupus patients are also at a high risk for preeclampsia, which Salmon said is an extremely important health problem in the United States and other developed countries.  According to the Preeclampsia foundation, the disorder is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. It affects both the mother and the unborn baby.

“We can use lupus as a window to study preeclampsia because it’s prevalent in these patients,” she said, “and if we can prevent it in them, why not others.”