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Certain biomarkers may predict pregnancy complications in women with SLE
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Women with systemic lupus erythematosus and certain serum biomarkers during pregnancy may be more likely to have adverse pregnancy outcomes, according to recently published research.
Researchers studied 492 pregnant women with systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) enrolled at 12 weeks gestation in a prospective, multicenter study between September 2003 and August 2013 in the U.S. and Canada. The study included 335 women with SLE without antiphospholipid (APL) antibodies, 59 women with SLE and APL, and 98 women with only APL.
Serum was monitored monthly for soluble fms-like tyrosine kinase-1 (sFlt1), placental growth factor (PIGF) and soluble endoglandin (sEng) and for pregnancy complications. A healthy control group of 197 pregnant women was recruited with similar ethnicity to patients and low risk for adverse pregnancy outcomes. Patients were excluded in the presence of 20 mg or higher daily prednisone use, urine protein to creatinine ratio greater than 1,000, urinary erythrocyte casts, serum creatinine greater than 1.2 mg/dL, type 1 or 2 diabetes or blood pressure above 140/90 mm Hg at the time of screening.
Fifty-nine (12%) severe and 49 (10%) moderate adverse pregnancy outcomes occurred within the cohort of patients. At 12 to 15 weeks of gestation, women who had adverse pregnancy outcomes had significantly raised sFlt1, sEng and a high sFlt1 to PIGF ratio, which increased over the duration of the pregnancy. Small but consistent levels and increases of sFlt1, sEng and a high sFlt1 to PIGF ratio were also observed in patients with SLE or APS who did not have adverse outcomes compared to 197 healthy participants who did not have adverse outcomes.
“Given that over 20% of pregnant women with lupus APL experience adverse pregnancy outcomes, the ability to identify patients early in pregnancy, who are destined for poor outcomes, would significantly impact care of this high-risk population,” investigator Jane E. Salmon, MD, of the Division of Rheumatology, Hospital for Special Surgery, and Weill Cornell Medical College, New York, NY, said in a press release.
The presence of lupus anticoagulant, a history of high blood pressure or thrombosis, diastolic blood pressure over 80 mm Hg and high BMI were baseline clinical variables associated with a higher risk for adverse pregnancy outcomes. The use of aspirin appeared to be protective, according to the researchers. – by Shirley Pulawski
Disclosure: Kim reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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