The Optimal Criteria for Patients with Systemic Lupus Erythematosus Should Meet Before Pregnancy: A Large-scale China Multicenter Study

Systemic lupus erythematosus (SLE) is often related to a lower rate of live birth and a higher incidence of adverse pregnancy outcomes (APOs), and pregnancy can lead to an increased risk of SLE flares. Comprehensive preconception assessment is crucial, but global consensus regarding the criteria the patients should meet before pregnancy has not been formed yet. This study, conducted retrospectively based on data from Chinese SLE Treatment and Research group (CSTAR) registry, a multicenter Chinese SLE cohort, aimed to investigate the optimal criteria. Analysis included 347 singleton pregnancies from 333 patients with SLE in total. The criteria that patients with SLE should meet before pregnancy were identified by univariate logistic regression analysis, which were: 1) disease stable for at least 6 months; 2) absent of vital organ damage; 3) on nonfluorinated corticosteroids no more than the dose equivalent to prednisone 7.5mg per day; 4) on hydroxychloroquine. The proportion of live birth was significantly higher in the group meeting the criteria (86.1% vs 73.7%, p=0.004). Furthermore, the gestational week at delivery (38.4 vs 37.6, p<0.001) and the birthweight (2956.7g vs 2810.2g, p=0.004) were significantly larger. Then, APOs occurred less frequently in the group meeting the criteria (29.4% vs 52.1%, p<0.001). For each type of APOs, the incidences of therapeutic abortion (5.0% vs 12.0%, p=0.019), preterm delivery (14.2% vs 33.3%, p<0.001), and preeclampsia (1.1% vs 5.4%, p=0.023) were remarkably lower. When it comes to disease flares, patients in group meeting the criteria experienced flares during pregnancy less frequently (14.7% vs 28.1%, p=0.005), as well as for severe flares (5.8% vs 15.6%, p=0.006). Results were similar when taking both gestation period and one year postpartum into consideration. The results of this study stress the importance of comprehensive preconception assessment and warrant the implementation of such criteria among patients with SLE in clinical practice.