A new study presented in November at the American College of Rheumatology's annual scientific meeting in Chicago offers reassurances for women with stable lupus who are considering pregnancy.

Systemic lupus erythematosus, also called SLE or lupus, is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system, and other organs of the body.

The most common symptoms include skin rashes and arthritis, often accompanied by fatigue and fever. Lupus occurs mostly in women, typically developing in individuals in their 20s and 30s—prime child-bearing age.

Lupus has been known to cause complications for pregnant women. Researchers recently set out to determine the frequency, predictors, and potential causes of these complications to help physicians better counsel women with lupus who are considering pregnancy.

The endeavor is part of a predictors of pregnancy outcome study funded by the National Institute of Arthritis, Musculo-skeletal and Skin Diseases of NIH.

Its goal is to identify biomarkers that would predict poor pregnancy outcomes in lupus patients. Researchers identified a few predictors of pregnancy complications, but also discovered that that the majority of women with stable lupus had successful pregnancies.

The researchers evaluated 333 women from their first trimester until three months after delivery. At entry into the study, none of the women were pregnant with more than one child, and their dosages of prednisone were below an accepted level. Also, none of the women in the study had abnormally high excretion of protein as evidenced by more than one gram of protein in their urine per 24 hours, and none had impaired kidney function.

Nearly half of the women were ethnicities other than Caucasian, and 31 percent had a history of previous lupus affecting their kidneys.

When enrolled in the study, 60 percent were taking hydroxychloroquine, 41 percent were taking prednisone, and 18 percent were taking azathioprine. On average, the participants' lupus was relatively inactive.

The researchers followed each participant to determine if any of the following serious complications occurred during their pregnancies: death of the baby or fetus, birth before 36 weeks of pregnancy due to a lack of oxygen or nutrients to the placenta, high blood pressure, preeclampsia—which is a combination of high blood pressure and protein in the urine—and birth of a baby of very small size relative to the gestational age (less than 5th percentile).

Two categories of pregnancy complications were evaluated, one related to the child and the other to the mother.

In terms of the child, the outcomes chosen for study were those that represented the worst outcome — death — or situations in which the well-being of the child would require extended hospitalization in a critical-care setting.

In terms of the mother, the outcomes focused on the development of mild, moderate, or severe increases of lupus activity, called flares.

Poor outcomes occurred in 63 of the participants. Of these, 19 experienced death of the baby and 30 delivered before 36 weeks or had newborns of small gestational size.

"This death rate is still not acceptable, but is actually much lower than most physicians have assumed," said Drs. Jill P. Buyon and Jane E. Salmon, of the Hospital of Specialty Surgery, of New York, in jointly worded observations about the study. "While confirming a lower death rate than expected is a step in the right direction, more research needs to be done to help ensure more successful pregnancies and healthy babies and mothers."

In addition, 10 percent of the mothers developed preeclampsia, 10 percent experienced mild or moderate flares at 20 weeks, and 8 percent experienced them at 32 weeks. Severe flares occurred very rarely, involving less than 3 percent of women at 20 weeks and at 32 weeks.

Overall, though, 80 percent of the women in the study had successful pregnancies, and Drs. Buyon and Salmon said those findings support advising lupus patients who wish to become pregnant that the best time is when the lupus is stable and they aren't experiencing a flare of the disease.

"Although it is acknowledged that health care delivery and monitoring of pregnancy has improved in the last decade, the observation that lupus patients with stable or inactive disease (even with preexisting kidney disease) can have a healthy baby is very reassuring," the doctors said.

Of the 20 percent of women who experienced pregnancy complications, the researchers noted those who entered the study with specific characteristics were more likely to have a pregnancy complication.

Those characteristics include higher levels of lupus activity and higher levels of antibodies that might put a person at risk for a blood clot. Additionally, women who experienced increased lupus activity at 20 or 32 weeks and a worsened physician's assessment of their health had a tendency toward complications in their pregnancies.

"This very large study including racial and ethnic minorities, provided evidence that women who conceived while their disease was stable or only mildly active had relatively infrequent flares during their pregnancies and delivered healthy babies," said Drs. Buyon and Salmon. "This held true regardless of past disease severity or past kidney disease (a frequent consequence of lupus). These findings inform women with lupus on how to best plan when to conceive to assure the most favorable outcome for themselves and their babies."

The American College of Rheumatology is an international professional medical society that represents more than 8,000 rheumatologists and rheumatology health professionals around the world.

The organization's mission is to advance rheumatology.