BACKGROUND Lupus patients are at risk for pregnancy loss, and it has been generally accepted that women with SLE should have low disease activity prior to conception. However, there are conflicting results regarding the effect of pregnancy on SLE flares. This study aims to identify predictors of flares during and after pregnancy in SLE patients with inactive or stable disease activity during the first trimester and to characterize and estimate the frequency of post-partum flares in these patients. METHODS SLE patients in the multicenter, prospective PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study were evaluated for flares during and after pregnancy using the SELENA-SLEDAI Flare Index. Flares during pregnancy were assessed in all 384 patients and post-partum flares in 234 patients with study visits 2-6 months post-partum. Logistic regression models were fit to the data to identify independent risk factors for flare. RESULTS During pregnancy, 20.8% of patients had mild/moderate flares and 6.25% had severe. Post-partum, 27.7% of patients had mild/moderate flares and 1.7% had severe. The mild flares rarely required treatment. Younger age, low C4 and higher PGA at baseline were independently associated with higher risk of having at least one mild/moderate or severe flare during pregnancy. Older patients were at decreased risk of flare, as well as those with quiescent disease at baseline. No variables evaluated at baseline or the visit most proximal to delivery was significantly associated with risk of flare post-partum. Medications were not associated with flare during or after pregnancy. CONCLUSION In patients with inactive or stable mild disease activity at the time of conception, lupus disease flares during and after pregnancy are typically mild and occur at similar rates. Flares during pregnancy are predicted by the patients' age and clinical and serological activity at baseline.

中文翻译：

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稳定的狼疮患者在妊娠和产后发生耀斑的频率较低。

背景技术狼疮患者有妊娠流产的风险，并且人们普遍认为患有SLE的女性在受孕之前应具有较低的疾病活动性。但是，关于妊娠对SLE耀斑的影响存在矛盾的结果。这项研究的目的是确定妊娠早期和失活前三个月中疾病活动不活跃或稳定的SLE患者耀斑的预测因素，并表征和估计这些患者产后耀斑的发生频率。方法在多中心，前瞻性PROMISSE（妊娠结局预测：抗磷脂抗体综合征和系统性红斑狼疮中的生物标志物）研究中的SLE患者使用SELENA-SLEDAI眩光指数评估了妊娠期间和妊娠后的眩晕。对所有384例患者的妊娠期间耀斑进行了评估，对234例在产后2-6个月进行研究访问的患者进行了产后耀斑评估。将逻辑回归模型拟合到数据以识别爆发的独立危险因素。结果怀孕期间，有20.8％的患者出现轻度/中度耀斑，而6.25％的患者则有严重的耀斑。产后，有27.7％的患者有轻度/中度耀斑，有1.7％的患者有严重的耀斑。轻微的耀斑很少需要治疗。基线时年龄较小，C4较低和PGA较高与妊娠期间发生至少一种轻度/中度或重度耀斑的较高风险独立相关。老年患者和基线时处于静止状态的患者发生火炬的风险降低。在基线或最接近分娩时的随访中，没有评估变量与产后发生耀斑的风险显着相关。药物在怀孕期间或之后与耀斑无关。结论对于受孕时没有活动或稳定的轻度疾病活动的患者，妊娠期间和妊娠后狼疮疾病的发作通常是轻度的，并且发生率相似。怀孕期间的耀斑由患者的年龄以及基线时的临床和血清学活动预测。