Maternal and fetal outcomes in Latin American SLE pregnancies: A systematic review and meta-analysis

Introduction

Systemic lupus erythematosus (SLE) predominantly affects women, especially during their reproductive years, leading to increased risks during pregnancy. Latina women develop SLE at a younger age, which increases their susceptibility to pregnancy complications such as pre-eclampsia, preterm birth and fetal growth restriction.

Objective

The purpose of this study is to systematically review maternal and fetal outcomes in pregnant Latina women with SLE and to perform a meta-analysis to assess specific risks associated with the disease.

Materials and methods

A systematic review according to PRISMA guidelines was performed (PubMed and SciELO), including studies on SLE and pregnancy in Latin America through December 2022. Eligible studies included case reports, cohort studies and clinical trials in pregnant women with SLE. The meta-analysis focused on key outcomes, including pre-eclampsia and lupus nephritis, with relative risk (RR) calculations.

Results

Forty-four studies with 2190 pregnancies were included. High rates of pre-eclampsia (11–52 %), preterm delivery (18.6–70.8 %), and fetal loss were reported. A decades-long analysis of pregnancy outcomes in SLE in Latin America shows increased research and improved care, with fetal loss rates decreasing from 35 % (1980–1999) to lower intrauterine (28 %) and neonatal (10 %) death rates in 2020–2023. Meta-analysis showed that lupus nephritis almost doubled the risk of pre-eclampsia (RR = 1.89, 95 % CI:1.40–2.55) compared to women without nephritis.

Conclusion

Latina women with SLE are at increased risk for adverse pregnancy outcomes, particularly pre-eclampsia and preterm delivery. Lupus nephritis and disease activity are major risk factors, highlighting the need for tailored care and early intervention to improve maternal and fetal outcomes in this population.