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Successful Pregnancy Outcomes for Most Women

Adapted media release - Nov 7 2011

Promising research led by investigators at Hospital for Special Surgery may offer hope for women with Lupus who once thought that pregnancy was too risky.

Results from the Multicenter National Institutes of health (NIH) funded PROMISSE initiative, being presented Monday, Nov. 7 and then during a press conference on Tuesday, Nov 8, during the American Rheumatology’s 2011 Annual Scientific Meeting in Chicago, show that most women with stable lupus can have successful pregnancies.

“There was a misconception, based on outdated experience, that women with lupus should not try to have children,” said Jane Salmon, M.D., the study’s senior author and Collette Kean Research Chair at Hospital for Special Surgery in New York City. “Now that our treatments are more effective and we have a better understanding of the disease, we can identify a window when pregnancy is safe and outcomes are good for mother and fetus. Historically, women with systemic lupus erythematosis (also known as SLE or lupus) have been advised not to become pregnant because of risks to their own and their fetus’ health. SLE is a chronic inflammatory disease, in which the body’s own immune system attack tissues of the body and can cause complications during pregnancy.
Drs. Salmon together with Jill Buyon from New York University Medical Center, and their collaborators evaluated 333 pregnant women with lupus from the PROMISSE Study (predictors of Pregnancy Outcome: Biomarkers in antiphospholid antibody Syndrome and Systemic Lupus Erythematosis), which seeks to identify biomarkers that predict poor pregnancy outcomes. The research team found that 80 percent of lupus patients had favourable pregnancy outcome.
Patients with Lupus may be free of symptoms for long periods of time and then experience a disease “flare,” when symptoms such as rash, joint pain, chest pain, swollen legs, bruising and/or fatigue suddenly appear. “Most women with stable lupus, defined as limited disease activity and no flares during the time of conception and the first trimester, had successful pregnancies,” explained Dr. Salmon, who is also the principal investigator of PROMISSE Study. “We learn from these results that timing is a most important element for successful pregnancy in women with lupus and that avoiding pregnancy during periods of increased disease activity is essential.” In the study, two categories of pregnancy were evaluated: the health of the mother and the fetus. The research team studied development of mild, moderate, or severe increases of lupus activity, or flares, in expectant mothers. For the fetus, the study examined the worst outcome– death– or situations in which the well being of the child would require extended hospitalization in a critical care unit.
Of the 333 women with lupus studied, 63 had poor outcomes. Ten percent of mothers experienced preeclampsia, a serious complication characterized by the onset of high blood pressure and appearance of protein in the urine. Ten percent experienced mild or moderate flares at 20 weeks and eight percent experienced flares at 32 weeks or had newborns of small gestational size – smaller in size than normal for the baby’s sex and gestational age, commonly defined as a weight below the 10th percentile for gestational age.
None of the women in the study was pregnant with more than one fetus, took more that 20 mg/d of prednisone, or had abnormally high excretion of protein or impaired kidney function. The women who experienced complications had more active lupus at 20 and 32 weeks and higher levels of antiphospholid antibodies.
References Article adapted by Medical News Today from original press release. The PROMISSE study was funded by the National Institute of Arthritis, Musculoskeletal and Skin Diseases of the National Institutes of Health in 2003 to identify biomarkers that would predict poor pregnancy outcomes in lupus patients. To date, the PROMISSE investigative team has enrolled 647 volunteers who are monitored with monthly checkups and research laboratory studies looking at genes and circulating proteins that may predict the course of pregnancy. PROMISSE will continue through 2013 with $12.3 million in support over ten years from the NIAMS and the office of Research in Women’s Health. Dr Salmon and co-investigators from11 academic centers will continue to examine a broad range of genes and molecular pathways that can affect pregnancy in women with lupus, and it is anticipated that their findings will have applications for the prevention of miscarriage and preeclampsia in healthy women. The PROMISSE Study is coordinated by Dr. Salmon; Other investigators include Michael Lockshin, M.D., and Lisa Sammaritano, M.D., at Hospital for Special Surgery; Jill Buyon, M.D. at University School of Medicine: Ware Branch, M.D., at University of Utah Health Sciences Center; Carl Laskin, M.D., at Mt Sinai Hospital in Toronto, Canada; Joan Merrill, M.D., at the Oklahoma Medical Research Foundation; Michelle Petri, M.D., MPH, at John Hopkins University School of Medicine; Mimi Kim, D.Sc., at Albert Einstein College of Medicine; and Mary Stephenson, M.D., at the University of Chicago. This page was printed from :http:/www.medicalnewstoday.com/ releases/237212.php

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