Evaluation of lupus anticoagulant, damage, and remission as predictors of pregnancy complications in systemic lupus erythematosus: the French GR2 study

Maddalena Larosa (1, 2) , Véronique Le Guern (2) , Gaëlle Guettrot-Imbert (2) , Nathalie Morel (2) , Noémie Abisror (3) , Chafika Morati-Hafsaoui (4) , Pauline Orquevaux (5) , Elisabeth Diot (6) , Andrea Doria (1) , Françoise Sarrot Reynauld (7) , Nicolas Limal (8) , Viviane Queyrel (9) , Odile Souchaud-Debouverie (10) , Laurent Sailler (11) , Maëlle Le Besnerais (12) , Tiphaine Goulenok (13) , Anna Molto (14, 15, 16) , Emmanuelle Pannier-Metzger (17) , Loic Sentilhes (18) , Luc Mouthon (2, 19) , Estibaliz Lazaro (18) , Nathalie Costedoat-Chalumeau (2, 15)

1 Unipd - Università degli Studi di Padova = University of Padua
2 Service de médecine interne et centre de référence des maladies rares [CHU Cochin]
3 CHU Saint-Antoine [AP-HP]
4 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
5 Hôpital universitaire Robert Debré [Reims]
6 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
7 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
8 Hôpital Henri Mondor
9 Hôpital l'Archet
10 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
11 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
12 CHU Rouen
13 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
14 Service de rhumatologie [CHU Cochin]
15 CRESS (U1153 / UMR_A 1125) - Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
16 ECaMO - [CRESS - U1153 / UMR_A 1125] - Clinical Epidemiology Applied to Osteoarticular Diseases | Épidémiologie clinique appliquée aux maladies rhumatismales et musculo-squelettiques
17 Service de Gynécologie et Obstétrique [Cochin]
18 CHU Bordeaux
19 IC UM3 (UMR 8104 / U1016) - Institut Cochin

Objectives: The specific roles of remission status, lupus low disease activity state (LLDAS), and damage accrual on the prognosis of pregnancies in women with systemic lupus erythematosus (SLE) are unknown. We analysed their impact on maternal flares and adverse pregnancy outcomes (APOs). Methods: We evaluated all women (≥18 years) with SLE enrolled in the prospective GR2 study with an ongoing singleton pregnancy at 12 weeks (one pregnancy/woman). Several sets of criteria were used to define remission, disease activity, and damage. APOs included: fetal/neonatal death, placental insufficiency with preterm delivery, and small-for-gestational-age birth weight. First trimester maternal and disease features were tested as predictors of maternal flares and APOs. Results: The study included 238 women (98.3% on hydroxychloroquine) with 230 live births. Thirty-five (14.7%) patients had at least one flare during the second/third trimester. At least one APO occurred in 34 (14.3%) women.Hypocomplementemia in the first trimester was the only factor associated with maternal flares later in pregnancy (p = 0.02), while several factors were associated with APOs. In the logistic regression models, damage by SLICC-Damage Index (OR 1.8, 95% CI: 1.1-2.9 for model 1 and OR 1.7, 95% CI: 1.1-2.8 for model 2) and lupus anticoagulant (LAC, OR 4.2, 95% CI: 1.8-9.7 for model 1; OR 3.7, 95% CI: 1.6-8.7 for model 2) were significantly associated with APOs. Conclusion: LAC and damage at conception were predictors of APOs, and hypocomplementemia in the first trimester was associated with maternal flares later in pregnancy in a cohort of pregnant patients with well-controlled SLE. Clinical trial registration number: ClinicalTrials.gov, https://clinicaltrials.gov, NCT02450396.

Mots clés: adverse pregnancy outcome; damage; pregnancy; remission; systemic lupus erythematosus

Domaines: Médecine humaine et pathologie

Maddalena Larosa, Véronique Le Guern, Gaëlle Guettrot-Imbert, Nathalie Morel, Noémie Abisror, et al.. Evaluation of lupus anticoagulant, damage, and remission as predictors of pregnancy complications in systemic lupus erythematosus: the French GR2 study. Rheumatology, 2022, ⟨10.1093/rheumatology/keab943⟩. ⟨hal-03528855⟩