Elevated pre-eclampsia risk in lupus nephritis and antiphospholipid syndrome: a nationwide Spanish registry analysis

Abstract

Objective: Evaluate the association of APS and SLE, focusing on LN, with risk of pre-eclampsia (PE) and PE with severity criteria (PESC).

Methods: Analysis of pregnant women admitted between 2016-2022, using data from the Spanish Hospital Discharge Database. Factors associated with PE and PESC, including early-onset PE, severe PE, eclampsia and HELLP syndrome were evaluated.

Results: Among 1 973 249 admissions, 1787 patients had SLE (9.1‰), with prior LN in 13.2%. SLE patients experienced higher PE (5.5% vs 2.1%) and PESC (2.1% vs 0.6%) rates; these rose further in SLE women with LN alone (PE: 10.3%, PESC: 4.2%) or with both LN and APS (PE: 22.7%, PESC: 9.1%) . Adjusted analyses showed PE and PESC were each associated with SLE (OR = 1.78, 95% CI 1.39-2.28; OR = 2.17, 95% CI 1.47-3.22), LN (OR = 1.94, 95% CI 1.18-3.19; OR = 2.45, 95% CI 1.18-5.09) and APS (OR = 1.53, 95% CI 1.28-1.84; OR = 1.91, 95% CI 1.44-2.54). Within SLE patients, baseline hypertension (OR = 4.27, 95% CI 2.45-7.44), LN (OR = 2.06, 95% CI 1.26-3.37) and APS (OR = 1.85, 95% CI 1.03-3.32) were linked to PE, while LN alone predicted PESC (OR = 2.88, 95% CI 1.41-5.91).

Conclusion: The risk of PE and PESC that patients with SLE exhibit is further amplified in those with a history of LN or APS. Recognizing SLE, APS and especially LN is crucial for precise risk stratification and tailored management to improve maternal and fetal outcomes.

Keywords: antiphospholipid syndrome; lupus nephritis; pre-eclampsia; severe pre-eclampsia; systemic lupus erythematosus.