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Role of foetal umbilical artery Doppler on prediction of adverse pregnancy outcomes in patients with systemic lupus erythematosus

1, 2, 3, 4, 5, 6

 

  1. Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  2. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  3. Department of Rheumatology and Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  4. Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  5. Department of Ultrasound, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
  6. Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. cdongying@163.com

CER10851
2018 Vol.36, N°5
PI 0871, PF 0878
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PMID: 29652653 [PubMed]

Received: 29/09/2017
Accepted : 26/02/2018
In Press: 13/04/2018
Published: 26/09/2018

Abstract

OBJECTIVES:
To investigate the foetal outcomes and examine the predictive value of the third-trimester umbilical artery Doppler in systemic lupus erythematosus (SLE) pregnancies.
METHODS:
Data of 180 pregnancies in 175 SLE patients from Jan 2007 to Jan 2017 were analysed retrospectively. Pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) of the umbilical artery flow velocity data were monitored by Doppler ultrasound.
RESULTS:
One or more composite adverse pregnancy outcomes (APOs) occurred in 46.7% of patients with SLE. A total of 62 (34.4%) pregnancies were pre-term birth, and 34 (18.9%) newborns were small for gestational age (SGA). Twenty-two of pregnancies (12.2%) resulted in foetal distress. In multivariate analysis, predictors of composite APOs included positive anti-Ro (OR 5.5, 95% CI 1.7–18.2, p=0.005) and low complement (OR 3.9, 95% CI 1.1–13.6, p=0.04). Doppler PI, RI, and S/D were significantly higher in the pre-term birth, SGA, and composite APO groups than in the patients without APOs. RI with cut-off values of 0.57 and 0.70 indicated the highest risk of pre-term birth and composite APOs, with sensitivities of 50.0% and 21.4%, as well as specificities of 59.6% and 97.7%, respectively. PI emerged as the best predictor of SGA. The optimal cutoff value for PI was 0.77, at which sensitivity (90.9%) and specificity (49.2%) had the best combination.
CONCLUSIONS:
Pregnancies in lupus still had an increased risk of APOs in terms of pre-term birth. Third-trimester umbilical artery Doppler was useful in predicting pre-term birth, SGA, and composite APOs in lupus pregnancies.

Rheumatology Article