Complications of Pregnancy in Patients with Systemic Lupus Erythematosus (Gabon)

Sosthène Mayi-Tsonga^1*, Landry Missounga², Josaphat Ibaba², Jean Ronald Edoa², Jean Baptiste Moussavou Kombila²

¹Obstetrics Department, Libreville’s Military Hospital, Libreville, Gabon.
²Department of Internal Medicine, Libreville’s Hospital University, Libreville, Gabon.

DOI: 10.4236/ojog.2015.58064                

Abstract

Pregnancy and systemic lupus erythematosus in black African women: about 10 cases in Libreville (Gabon). Objectives: Through a study in a population of systemic lupus erythematosus (SLE) pregnant black Gabonese women, we describe the characteristics of these pregnancies to clarify their main complications and to make recommendations to their follow-up in low resource countries. Patients and Methods: This is a longitudinal descriptive study conducted over a period of six years, from 1 January 2008 to October 31, 2013, in Libreville (Gabon). We’ve included, systemic lupus erythematosus women carrying a pregnancy during the period of the study. Results: Seventy-two SLE women were followed and were eligible. Only 8 patients (11%) were pregnant during the follow up period. These 8 SLE patients allowed us to monitor 10 pregnancies. The average parity was 0.88. Eight pregnancies in ten (80%) had complications and most frequent was preeclampsia. Nine pregnancies (90%) resulted in the birth of viable children of which 4 (44.4%) were born by caesarean section and the 5 others (55.6%) were born by natural route. Conclusion: We recommend a monthly prenatal care for these high-risk pregnancies and early detection of preeclampsia.

Keywords

Systemic Lupus Erythematosus, Pregnancy, Preeclampsia, Gabon

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Waldorf, K.M.A. and Nelson, J.L. (2008) Autoimmune Disease during Pregnancy and the Microchimerism Legacy of Pregnancy. Immunological Investigations, 37, 631-644. http://dx.doi.org/10.1080/08820130802205886
[2]	Bae, S.C., Fraser, P. and Liang, M.H. (1998) The Epidemiology of Systemic Lupus Erythematosus in Populations of African Ancestry: A Critical Review of the “Prevalence Gradient Hypothesis”. Arthritis & Rheumatology, 41, 2091-2099. http://dx.doi.org/10.1002/1529-0131(199812)41:12<2091::AID-ART2>3.0.CO;2-D
[3]	Borchers, A.T., Naguwa, S.M. and Carl, L. (2010) The Implications of Autoimmunity and Pregnancy. Journal of Autoimmunity, 34, J287-J299. http://dx.doi.org/10.1016/j.jaut.2009.11.015
[4]	Carvalheiras, G., Vita, P., Marta, S., Trovao, R., Farinha, F., Braga, J., et al. (2010) Pregnancy and Systemic Lupus Erythematosus: Review of Clinical Features and Outcome of 51 Pregnancies at a Single Institution. Clinical Reviews in Allergy & Immunology, 38, 302-306. http://dx.doi.org/10.1007/s12016-009-8161-y
[5]	Clowse, M.E., Magder, L.S., Witter, F. and Petri, M. (2006) Early Risk Factors for Pregnancy Loss in Lupus. Obstetrics & Gynecology, 107, 293-299. http://dx.doi.org/10.1097/01.AOG.0000194205.95870.86
[6]	Cortés-Hernández, J., Ordi-Ros, J. and Paredes, F. (2002) Clinical Predictors of Fetal and Maternal Outcome in Systemic Lupus Erythematosus: A Prospective Study of 103 Pregnancies. Rheumatology, 41, 643-650. http://dx.doi.org/10.1093/rheumatology/41.6.643
[7]	De Bandt, M. (2005) Lupus et grossesse. Revue de Rhumatisme, 72, 554-562. http://dx.doi.org/10.1016/j.rhum.2004.12.009
[8]	Direction Générale de la Statistique (DGS) et ICF International (2013) Enquête Démographique et de Santédu Gabon II. Calverton, Maryland, et Libreville, Gabon: DGS et ICF International. www.stat-gabon.ga
[9]	Frouchet, M., Gateff, C. and Pineau, J. (1969) Lupus érythémateux aigu disséminé chez l’africain. A propos du premier cas observé au Gabon. Medicine Tropical, 29, 204-207.
[10]	Ibaba, J., Nzenzé, J.R. and Biteghé, B. (2011) Profil épidémiologique, diagnostic, thérapeutique et évolutif du lupus systémique en Afrique subsaharienne. Expérience du service de médecine interne du Centre Hospitalier de Libreville: A propos de 37 observations. Médecine d’Afrique Noire, 58, 551-559. www.santetropicale.com
[11]	Le Guern, V., Pannier, E. and Goffinet, F. (2008) Lupus érythémateux systémique et grossesse. La Presse Médicale, 37, 1627-1635. http://dx.doi.org/10.1016/j.lpm.2008.09.001
[12]	Le Thi Huong, D., Wechsler, B. and Piette, J.C. (2002) Kidney, Lupus and Pregnancy. Revue de Médecine Interne, 23, 813-818. http://dx.doi.org/10.1016/S0248-8663(02)00696-3
[13]	Le Thi Huong, D., Wechsler, B. and Piette, J.C. (1994) French Register of Lupus in Pregnancy: The Evaluation. Groupe d’étude sur la grossesse lupique. Revue de Médecine Interne, 15, 305-317.
[14]	Moroni, G. and Ponticelli, C. (2003) The Risk of Pregnancy in Patients with Lupus Nephritis. Journal of Nephrology, 16, 161-167.
[15]	Petri, M. (2005) Review of Classification Criteria for Systemic Lupus Erythematosus. Rheumatic Disease Clinics of North America, 31, 245-254. http://dx.doi.org/10.1016/j.rdc.2005.01.009
[16]	Petri, M. and Repke, J. (1991) Frequency of Lupus Flare in Pregnancy. The Hopkins Lupus Pregnancy Center Experience. Arthritis & Rheumatology, 34, 1538-1545. http://dx.doi.org/10.1002/art.1780341210
[17]	Robert, Y. (2007) Doppler en obstétrique. In: Robert, Y., Ed., Echographie en pratique obstétricale, Ardens, E Masson, Paris, 102-105.