Maternal and fetal complications associated with systemic lupus erythematosus An updated meta-analysis of the most recent studies (2017-2019)

Background: Recent guidelines provide better treatment and management of pregnancy in women with systemic lupus erythematosus (SLE). In this analysis, we aimed to systematically assess the maternal and fetal complications associated with SLE using the most recent studies (2017-2019) to obtain an updated result of the present situation. Methods: http://www.clinicaltrials.gov, MEDLINE, Cochrane Central, Web of Science, EMBASE, and Google Scholar were searched for English based studies comparing maternal and fetal complications in pregnant women with versus without SLE. Maternal and fetal complications were the endpoints in this analysis. The RevMan software 5.3 (latest version) was the most suitable analytical software for this analysis. Data were represented by risk ratio (RR) with 95% confidence interval (CI). Results: A total number of eight million eight hundred and twelve thousand two hundred seventy-two (8,812,272) participants were included in this analysis, consisting of 9696 SLE-associated pregnancy. Based on an analysis of recently published studies (2017-2019), pre-eclampsia/eclampsia was significantly higher in pregnant women with SLE (RR: 3.38, 95% CI: 3.15-3.62; P = .00001). SLE was also associated with an increased risk of stillbirth (RR: 16.49, 95% CI: 2.95-92.13; P = .001) and fetal loss (RR: 7.55, 95% CI: 4.75-11.99; P = .00001). Abortion (RR: 4.70, 95% CI: 3.02-7.29;P = .00001) and the risk for cesarean section due to complications (RR: 1.38, 95% CI: 1.11-1.70;P = .003) were also significantly higher in pregnant women with SLE. In addition, fetal complications including preterm birth (RR: 2.33, 95% CI: 1.78-3.05;P = .00001), infants who were small for gestational age (RR: 2.50, 95% CI: 1.41-4.45;P = .002) and infants with low birth weight (RR: 4.78, 95% CI: 3.65-6.26;P = .00001) were also significantly higher in newborns from mothers with SLE. Moreover, the risk of newborns who were admitted to the neonatal intensive care unit (RR: 2.79, 95% CI: 2.31-3.37;P = .00001), newborns with an APGAR score <7 within 1 minute (RR: 2.47, 95% CI: 1.68-3.62;P = .00001) and 5 minutes (RR: 3.63, 95% CI: 2.04-6.45;P = .0001) respectively, were significantly highly associated with SLE. Conclusions: Based on the most recent studies, we could conclude that maternal and fetal complications were significantly higher in SLE-associated pregnancy. Therefore, SLE should still be considered a severe risk factor for pregnancy.