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SLE and Pregnancy and Prognosis? Buyon JP, Kim MY, Guerra MM, et al. Original Research: Predictors of Pregnancy Outcomes in Patients With Lupus: A Cohort Study. Ann Intern Med. Published online 23 June 2015 doi:10.7326/M14-2235 Hahn BH. Editorial: Pregnancy in Women With Systemic Lupus Erythematosus: Messages for the Clinician. Ann Intern Med. Published online 23 June 2015 doi:10.7326/M15-1301 The good news: Among pregnant women with systemic lupus erythematosus (SLE), 81% had a good outcome. The bad news: Among Hispanic white and African-American women, only 74% had a good outcome. (“Good outcome” means not having an adverse pregnancy outcome (APO), which includes fetal or neonatal death, birth <36 weeks due to placental insufficiency, hypertension, pre-eclampsia, and <5th percentile of birth weight.) Total No APOs Non-Hispanic white 157 (85%) 27 (15%) Hispanic white 43 (74%) 15 (26%) African-American 58 (74%) 20 (26%) Other/No answer 54 (83%) 11 (17%) Total 312 (81%) 73 (19%) APO = adverse pregnancy outcome. P=0.053 That’s the result of the Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody syndrome and Systemic Lupus Erythematosus(PROMISSE) study, the largest study to date, with 385 patients and 198 healthy controls. The best results (92%) were achieved by non-Hispanic white women with negative lupus anticoagulant test results, no treatment for hypertension, no or low disease activity, and platelet counts of at least 100 x 109 cells/L. Fetal or neonatal deaths occurred in only 3.9%, which is similar to healthy control participants. Among all 385 pregnancies, 5% ended in fetal or neonatal death. PROMISSE identified characteristics of US women who had good and bad outcomes. Multivariant analysis revealed several predictors of poor fetal outcomes. Being non-Hispanic white had an odds ratio of 0.45 (confidence interval 0.24-0.84) for having an APO at any time during pregnancy. Other characteristics were: -- Anti-hypertensive use at baseline -- Presence of lupus anticoagulant -- Clinical flare at any time during pregnancy -- Moderate clinical disease at baseline APOs were not associated with anti-dsDNA. In an editorial, Bevra Hahn suggests: -- Pregnancies should be planned as much as possible and timed to occur when disease activity is lowest. -- Every pregnancy during SLE is high-risk, and a high-risk obstetrician should be involved. -- SLE should be controlled as tightly as possible. Flares occur in approximately 50% of pregnant women. Nonfluorinated glucocorticoids are the mainstay of treatment, and hydroxychloroquine seems to be safe for the fetus. For the approximately 40% of patients positive for anticardiolipin, low-dose aspirin plus heparin is recommended