The lowest surviving birth weight reported in a systemic lupus erythematosus patient: a review of the literature

Abstract

The success rates for pregnancies in women with systemic lupus erythematosus(SLE) have improved over the years: however, pregnancy for women with active, serious, organ-threatening lupus continues to be a challenge. Preeclampsia and HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome may complicate pregnancy especially in the setting of advanced maternal age, underlying SLE and chronic renal disease.

We report the pregnancy course and outcome for a 35-year old woman with active lupus nephritis at the time of conception who developed severe preeclampsia and HELLP syndrome. The infant was delivered at 26-5/7 weeks gestation, which, associated with intrauterine growth retardation, led to a birth weight of only 470 g. We have reviewed the relevant literature for similar cases of prematurity, very low birth weight, and preeclampsia in the setting of underlying lupus in Medline between 1986 and 2006. This report represents the lowest birth weight pregnancy survival in a lupus patient and the first case of a survival in the second trimester with preeclampsia and HELLP syndrome.

Keywords

HELLP syndrome lupus nephritis preeclampsia pregnancy outcomes prematurity systemic lupus erythematosus

Get full access to this article

View all access options for this article.

References

Hahn BH. An overview of the pathogenesis of systemic lupus erythematosus. In Hahn BH , Wallace DJ eds. Dubois' lupus erythematosus. Williams & Wilkins , 2001: 87–96.

Kitridou RC. The mother in systemic lupus erythematosus. In Hahn BH , Wallace DJ eds. Dubois' systemic lupus erythematosus. Williams & Wilkins , 2001: 985–1021.

Cunningham FG , Leveno KJ , Bloom SL , Hauth JC , Gilstrap LC , Wenstrom KD eds. Hypertensive disorders of pregnancy. Williams' obstetrics. McGraw-Hill , 2005: 761–808.

McCarty D , Manzi S , Medsger T , Ramsey-Goldman R , LaPorte R , Kwoh C . Incidence of systemic lupus erythematosus: race and gender differences . Arthritis Rheum 1995; 38: 1260–1270 .

Lockshin M. Pregnancy does not cause systemic lupus erythematosus to worsen . Arthritis Rheum 1989; 32: 665–670 .

Molad Y , Borkowski T , Monselise A et al. Maternal and fetal outcome of lupus pregnancy: a prospective study of 29 pregnancies . Lupus 2005; 14: 145–151 .

Petri M , Howard D , Repke J . Frequency of lupus flare in pregnancy. The Hopkins Lupus Pregnancy Center Experience . Arthritis Rheum 1991; 34: 1538–1545 .

Mintz G , Niz J , Gutierrez G , Garcia-Alonso A , Karchmer S . Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach . J Rheumatol 1986; 13: 732–739 .

Urowitz M , Gladman D , Farewell V , Stewart J , McDonald J . Lupus and pregnancy studies . Arthritis Rheum 1993; 36: 1392–1397 .

10.

Moroni G , Ponticelli C . Pregnancy after lupus nephritis . Lupus 2005; 14: 89–94 .

11.

Moroni G , Ponticelli C . The risk of pregnancy in patients with lupus nephritis . J Nephrol 2003; 16: 161–167 .

12.

Haddad B , Deis S , Goffinet F , Paniel BJ , Cabrol D , Sibai BM . Maternal and perinatal outcomes during expectant management of 239 severe preeclamptic women between 24 and 33 weeks' gestation . Am J Obstet Gynecol 2004; 190: 1590–1597 .

13.

McCrae K , Samuels P , Schreiber A . Pregnancy-associated thrombocytopenia: pathogenesis and management . Blood 1992; 80: 2697–2614 .

14.

Kohelet D , Arbel E , Shochat R , Tavori I . Survival of a 300-g infant ventilated by high-frequency oscillatory ventilation for respiratory distress syndrome . Crit Care Med 2002; 30: 1152–1155 .

15.

Jenkins S , Head B , Hauth J . Severe preeclampsia at <25 weeks of gestation: maternal and neonatal outcomes . Am J Obstet Gynecol 2002; 186: 790–795 .