Evaluation of lupus anticoagulant, damage, and remission as predictors of pregnancy complications in systemic lupus erythematosus: the French GR2 study
Author:
Larosa Maddalena12, Le Guern Véronique1, Guettrot-Imbert Gaëlle1, Morel Nathalie1, Abisror Noémie3, Morati-Hafsaoui Chafika4, Orquevaux Pauline5, Diot Elisabeth6, Doria Andrea2ORCID, Sarrot-Reynauld Françoise7, Limal Nicolas8, Queyrel Viviane9, Souchaud-Debouverie Odile10, Sailler Laurent11, Le Besnerais Maëlle12, Goulenok Tiphaine13ORCID, Molto Anna1415ORCID, Pannier-Metzger Emmanuelle16, Sentilhes Loic17, Mouthon Luc118, Lazaro Estibaliz19, Costedoat-Chalumeau Nathalie115, Banneville Béatrice, Baudet Antoine, Beaudouin-Bazire Constance, Belizna Cristina, Belkhir Rakiba, Benhamou Ygal, Berezne Alice, Berthier Sabine, Berthoux Emilie, Bezanahary Holy, Biale Lisa, Bienvenu Boris, Blanchard-Delaunay Claire, Calas Anne, Cathebras Pascal, Cazalets Claire, Chaigne Benjamin, Chandesris Olivia, Chatelais Jérémy, Chatelus Emmanuel, Chauvet Elodie, Cohen Fleur, Coquerelle Pascal, Couderc Marion, de Menthon Mathilde, de Moreuil Claire, Delforge Juliette, Dellal Azeddine, Deneux-Tharaux Catherine, Denis Amélie, Dernis Emmanuelle, Deroux Alban, Desouches Sandra, Direz Guillaume, Dougados Maxime, Driessen Marine, Du Thanh Aurélie, Dunogeant Laetitia, Durant Cécile, Durieu Isabelle, Elefant Elisabeth, Fabre Marc, Fain Olivier, Ferreira-Maldent Nicole, Flipo René-Marc, Frazier Aline, Froissart Antoine, Georgin-Lavialle Sophie, Gervais Elisabeth, Godeau Bertrand, Goffinet François, Gompel Anne, Gossec Laure, Goupille Phillipe, Grange Claire, Guillaud-Danis Constance, Hachulla Eric, Hummel Aurélie, Jallouli Moez, Jego Patrick, Jobard Stéphane, Josselin-Mahr Laurence, Jourde-Chiche Noémie, Korganow Anne-Sophie, Lambert Marc, Langlois Vincent, Lariviere Delphine, Larroche Claire, Lartigau-Roussin Céline, Latourte Augustin, Lavigne Christian, Le Gallou Thomas, Leroux Gaëlle, Levesque Hervé, Lioté Frédéric, Loeuillet Laurence, London Jonathan, Loustau Valentine, Maheu Emmanuel, Mahevas Matthieu, Maillard Hélène, Mariette Xavier, Marotte Hubert, Martin-Silva Nicolas, Martis Nihal, Masseau Agathe, Maurier François, Mekinian Arsène, Melboucy-Belkhir Sara, Michaud Martin, Michel Marc, Morel Jacques, Moulis Guillaume, Ora Jérémy, Pasquier Elisabeth, Pennaforte Jean-Loup, Perlat Antoinette, Bauer Hélène Petit, Perard Laurent, Pillebout Evangeline, Piot Jean-Maxime, Plu-Bureau Geneviève, Poindron Vincent, Portier Agnès, Pugnet Gregory, Raffray Loïc, Regent Alexis, Richez Christophe, Roriz Mélanie, Sauvetre Gaëtan, Savey Léa, Schleinitz Nicolas, Sellam Jeremy, Seror Raphaele, Sobanski Vincent, Sordet Christelle, Soubrier Martin, Stankovic-Stojanovic Katia, Tieulé Nathalie, Thomas Thierry, Timsit Marie-Agnès, Tsatsaris Vassilis, Urban Maria Letizia, Urbanski Geoffrey, Yelnik Cécile,
Affiliation:
1. Service de Médecine Interne, Centre de Référence Maladies Autoimmunes et Systémiques Rares Île de France, APHP Hôpital Cochin , Paris, France 2. Rheumatology Unit, Department of Medicine-DIMED, University of Padova , Padova, Italy 3. Service de Médecine Interne, Hôpital Saint Antoine , Paris 4. Service d’Infectiologie et Médecine Interne, CH Annecy Genevois—Site d'Annecy , Annecy 5. Service de Médecine Interne, Hôpital Robert Debré, CHU de Reims , Reims 6. Service de Médecine Interne, CHRU de Tours—Hôpital Bretonneau , Tours 7. Service de Médecine Interne, Centre Hospitalier Universitaire Grenoble Alpes , Grenoble 8. Service de Médecine Interne, CHU Henri Mondor , Créteil 9. Service de Rhumatologie, CHU L'Archet , Nice 10. Service de Médecine Interne, CHU Poitiers , Poitiers 11. Service de Médecine Interne, CHU Toulouse , Toulouse 12. Service de Médecine Interne, CHU Rouen , Rouen 13. Service de Médecine Interne, Hôpital Bichat Claude Bernard 14. AP-HP, Hôpital Cochin, Service de Rhumatologie 15. Université de Paris, Centre de Recherche Épidémiologie et Bio Statistiques de Sorbonne Paris Cité 16. Service de Maternité Gynécologie Obstétrique Port-Royal, Hôpital Cochin , Paris 17. Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Bordeaux , Bordeaux 18. INSERM U1016, CNRS UMR8104, Université de Paris , Paris 19. Service de Médecine Interne et Maladies Infectieuses (Sud), Centre Hospitalier Universitaire de Bordeaux , Bordeaux, France
Abstract
Abstract
Objectives
The specific roles of remission status, lupus low disease activity state (LLDAS), and damage accrual on the prognosis of pregnancies in women with SLE are unknown. We analysed their impact on maternal flares and adverse pregnancy outcomes (APOs).
Methods
We evaluated all women (≥18 years) with SLE enrolled in the prospective GR2 study with an ongoing singleton pregnancy at 12 weeks (one pregnancy/woman). Several sets of criteria were used to define remission, disease activity and damage. APOs included: foetal/neonatal death, placental insufficiency with preterm delivery and small-for-gestational-age birth weight. First trimester maternal and disease features were tested as predictors of maternal flares and APOs.
Results
The study included 238 women (98.3% on hydroxychloroquine (HCQ)) with 230 live births. Thirty-five (14.7%) patients had at least one flare during the second/third trimester. At least one APOs occurred in 34 (14.3%) women. Hypocomplementemia in the first trimester was the only factor associated with maternal flares later in pregnancy (P=0.02), while several factors were associated with APOs. In the logistic regression models, damage by SLICC-Damage Index [odds ratio (OR) 1.8, 95% CI: 1.1, 2.9 for model 1 and OR 1.7, 95% CI: 1.1, 2.8 for model 2] and lupus anticoagulant (LA, OR 4.2, 95% CI: 1.8, 9.7 for model 1; OR 3.7, 95% CI: 1.6, 8.7 for model 2) were significantly associated with APOs.
Conclusion
LA and damage at conception were predictors of APOs, and hypocomplementemia in the first trimester was associated with maternal flares later in pregnancy in this cohort of pregnant patients mostly with well-controlled SLE treated with HCQ.
Trial registration
ClinicalTrials.gov, https://clinicaltrials.gov, NCT02450396.
Funder
Lupus France; association des Sclérodermiques de France AFM-Telethon, the French Society of Internal Medicine French Society of Rheumatology CMEL commission for Research and Innovation of Cochin Hospital Ministère de la Santé Clinical REsearch Contract—Database Foundation for Research in Rheumatology
Publisher
Oxford University Press (OUP)
Subject
Pharmacology (medical),Rheumatology
Cited by
26 articles.
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