Blood test will identify pregnant women with lupus who have low risk of adverse outcomes
Pregnant women with systemic lupus erythematosus have a higher risk of adverse pregnancy outcomes but monitoring specific biomarkers in maternal blood during early pregnancy can successfully predict who is likely to have a normal pregnancy, experts explain in the American Journal of Obstetrics & Gynecology. The finding will allow healthcare professionals to identify and manage women at high risk early on and improve outcomes.
Systemic lupus erythematosus (SLE) is an autoimmune disease that mainly affects women and is often diagnosed during childbearing years. The immune system that normally protects against infection turns against the woman and can cause damage to multiple organs. Another condition, antiphospholipid antibodies (APL) can occur in people with or without SLE and can damage the placenta and cause blood clots.
Current study
A total of 497 pregnant women with SLE and/or APL were enrolled before they were 12 weeks pregnant and compared to 207 matched healthy women.
The research group found that specific biomarkers (angiogenic factors that regulate development of the placenta and influence the health of blood vessels in the mother) can be assessed early in pregnancy. And as early as 12–15 weeks into pregnancies, changes in these biomarkers can signal an increased risk for severe complications.
Most women with SLE and APL currently have extensive antenatal evaluation, including serial obstetrical ultrasound exams and multiple visits to rheumatologists and obstetricians.
But measuring the biomarkers had a high negative predictive value, ie severe complications could actually be ruled out in most patients, leading to more appropriate prenatal care and less anxious patients.
“Given that over 20% of pregnant women with lupus APL experience adverse pregnancy outcomes, the ability to identify patients early in pregnancy, who are destined for poor outcomes, would significantly impact care of this high risk population,” explains Dr Jane Salmon, who led the work.
“Pregnancies in patients with SLE and/or APL can result in poor outcomes, even when disease activity is low, and baseline clinical features and laboratory tests have only modest ability to identify patients at highest risk for adverse pregnancy outcomes. Our study is the first to demonstrate, in a prospective cohort, the usefulness of angiogenic biomarkers measured as early as the 12th week of pregnancy, in combination with clinical criteria, to identify patients with SLE and/or APL at risk of severe adverse pregnancy outcomes.”
Dr Roberto Romero, editor-in-chief for obstetrics of the American Journal of Obstetrics & Gynecology, comments:
“A fundamental question of pregnant mothers with lupus or antiphospholipid antibody syndrome is whether their pregnancy will turn out fine or they will develop complications of pregnancy. This important study indicates that if the concentration of biomarkers measured in maternal blood in early pregnancy is normal, over 95% of the pregnancies will not develop preeclampsia, fetal growth restriction, or death. Therefore, the simple measurement of these biomarkers can be highly reassuring to mothers, families, and physicians.”
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Image credit: Jens Bergander
