Kidney Week

Abstract: SA-PO1048

Unplanned Pregnancy in Women with Lupus Nephritis Is Common and Is Associated with Poor Fetal Outcomes

Session Information

• Women's Health and Kidney Diseases
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Women's Health and Kidney Diseases

• 2200 Women's Health and Kidney Diseases

Authors

• Beckwith, Hannah K.S., Imperial College Healthcare NHS Trust, London, United Kingdom

Hannah K.S. Beckwith, MBChB, PhD

• Wilson, Hannah R,, Imperial College London, London, United Kingdom

Hannah R, Wilson, PhD, MBBS

• Turner-Stokes, Tabitha, Imperial College London, London, United Kingdom

Tabitha Turner-Stokes

• Pluess, Marlene, Imperial College Healthcare NHS Trust, London, United Kingdom

Marlene Pluess, MD

• Condon, Marie B., Imperial College Healthcare NHS Trust, London, United Kingdom

Marie B. Condon, MD

• Cairns, Tom, Imperial College Healthcare NHS Trust, London, United Kingdom

Tom Cairns, MBBS

• Webster, Philip, Imperial College Healthcare NHS Trust, London, United Kingdom

Philip Webster, MBBS, PhD

• Lightstone, Liz, Imperial College London, London, United Kingdom

Liz Lightstone, MBBS, PhD

Background

Lupus Nephritis (LN) is a frequent organ manifestation of Systemic Lupus Erythematous among women of childbearing age. Whilst disease activity is known to correlate negatively with pregnancy outcomes(1), the frequency of unplanned pregnancies in people with LN and subsequent maternal-fetal outcomes have not yet been reported.

Methods

All women <35yrs at the time of diagnostic renal biopsy at our centre (01/01/1996-31/12/2016) were included in the study. Our standard practice is to offer pre-pregnancy counselling (PPC). Case notes were manually reviewed and clinical and biochemical data extracted. Pregnancies prior to LN diagnosis were excluded. Pregnancies were considered unplanned when:
a. PPC had not occurred or
b. teratogenic medication(s) were used peri-conception or
c. when pregnancies were reported as unintended.

Results

There were 179 pregnancies in 87/201 women (43%). The median length of follow up was 14.2 years (range 9.4-19.5).

37/179 (21%) pregnancies were unplanned and 128/178 (72%) pregnancies* resulted in a live birth. Unplanned pregnancy resulted in significantly worse fetal outcomes (Table 1) and 50% of unplanned pregnancies did not progress >20 weeks gestation (P=0.0004).

25/201 women (12%) sought help for primary or secondary infertility following a diagnosis of LN and 3 were diagnosed with premature ovarian failure (1.5%).

Conclusion

This study is the largest single centre cohort of LN pregnancies reported to date. Planned pregnancies have excellent outcomes, however 1 in 5 pregnancies are unplanned: these are associated with poor fetal outcomes and high rates of pregnancy loss.

Reference
1. Bundhun et al (2017). Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: A meta-analysis of studies published between years 2001-2016. J Autoimmun;79:17-27.

Table 1

^a 2-tailed Fisher’s exact t test ^b Unpaired t test *One person is currently pregnant