Does cutaneous lupus erythematosus have more favorable pregnancy outcomes than systemic disease? A two-center study

Objective To compare pregnancy outcomes in cutaneous lupus erythematosus (CLE) with systemic lupus erythematosus (SLE) and healthy pregnant women. Design Cohort comparative study. Setting Two university maternity centers in Saudi Arabia and Egypt. Population Pregnant women with CLE and SLE and healthy pregnant women. Methods Over a three-year period, 201 participants were allocated to three groups: group 1 (n = 67) contained women with CLE, group 2 (n = 67) women with SLE, and group 3 healthy controls (n = 67). Diagnosis of lupus erythematosus was based on American College of Rheumatology criteria. All participants were followed until delivery. Lupus exacerbation was evaluated by Lupus Activity Index score. ANOVA and chi-squared tests were used to compare obstetrical and neonatal outcomes, and regression analysis was used to define independent factors of adverse pregnancy outcomes. Main outcome measures Pregnancy losses, preterm labor, intrauterine growth restriction, preeclampsia, neonatal intensive care unit admissions, cesarean sections and lupus exacerbations. Results There was no significant difference between groups 1 and 3 in rates of pregnancy loss, preterm labor, preeclampsia, intrauterine growth restriction and neonatal intensive care admission. Group 1 had lower pregnancy loss (p = 0.005), growth restriction (p = 0.001), preeclampsia (p = 0.05), neonatal intensive care admissions (p = 0.001), cesarean section (p = 0.03), lupus exacerbations (p = 0.05) and anti-phospholipid antibodies (p = 0.02) compared with group 2. In groups 1 and 2, lupus exacerbation and anti-phospholipid antibodies were significant independent factors for adverse outcomes. Conclusions Cutaneous lupus erythematosus means comparable pregnancy outcomes to those of the healthy population. Lower rates of disease exacerbation and anti-phospholipid antibodies are potential factors for better pregnancy outcome in CLE compared with SLE. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.