Impact of disease activity on pregnancy outcomes and risk factors for fetal loss in systemic lupus erythematosus: a single-center cohort study.

Objectives: To investigate the impact of systemic lupus erythematosus (SLE) disease activity on neonatal outcomes and analyze risk factors associated with fetal loss in SLE pregnancies.

Material and methods: This retrospective study analyzed 102 pregnancies in 99 women with SLE at the First Affiliated Hospital of Fujian Medical University, China, between 2013 and 2020. Demographic data, live birth outcomes, and fetal loss were evaluated.

Results: Significant differences were observed among SLE disease activity groups in early preterm birth (χ² = 9.825, p < 0.05), term birth (χ² = 13.320, p < 0.05), neonatal birth weight (F = 8.688, p < 0.05), small for gestational age (χ² = 12.291, p < 0.05), neonatal intensive care unit (NICU) admission (χ² = 9.820, p < 0.05), neonatal infection (χ² = 9.227, p < 0.05), and neonatal myocardial injury (χ² = 7.033, p < 0.05). Multivariate logistic regression analysis identified unplanned pregnancy [adjusted odds ratio (aOR) = 2.772, 95% confidence interval (CI): 1.321-5.814], moderate-to-severe SLE activity (aOR = 4.537, 95% CI: 2.103-9.789), preeclampsia (aOR = 6.223, 95% CI: 2.845-13.615), 24-hour urinary protein > 1.0 g (aOR = 3.682, 95% CI: 1.726-7.854), and positive antiphospholipid antibodies (aOR = 5.250, 95% CI: 2.437-11.308) as independent risk factors for fetal loss (all p < 0.05). Medication initiated at least six months before pregnancy, particularly hydroxychloroquine, was associated with reduced fetal loss (aOR = 0.378, 95% CI: 0.185-0.772, p < 0.05).

Conclusions: Planned pregnancy, early initiation of hydroxychloroquine treatment, and close monitoring of disease activity, urinary protein, antiphospholipid antibodies, and blood pressure are crucial strategies to reduce fetal loss in SLE pregnancies. Early intervention for abnormal parameters may improve outcomes.