Lúpus eritematoso sistêmico e gestação: análise dos desfechos maternos em uma coorte de um hospital terciário

Abstract

Due to the higher prevalence of systemic lupus erythematosus (SLE) in women of childbearing age, pregnancy in these patients is not an uncommon condition. However, pregnant women with SLE have higher maternal and fetal morbidity and mortality than the rest of the population, requiring differentiated prenatal care. There is a higher risk of disease activity during pregnancy, as well as a higher frequency of preeclampsia (PE), premature birth, intrauterine growth restriction, and gestational loss. The clinical manifestations of SLE, in addition to being associated with adverse gestational outcomes, can mimic obstetric complications and hinder appropriate care provided to pregnant women. The aim of this thesis was to evaluate maternal clinical outcomes in a cohort of pregnant women with systemic lupus erythematosus, focusing more on neurological and renal manifestations, and to analyze the use of angiogenic (VEGF, PlGF) and antiangiogenic (sFlt-1) factors in the differential diagnosis between SLE nephritis and preeclampsia. In study 1, only a small number of patients had active neurological disease during pregnancy, and the high incidence of PE and prematurity were directly related to concomitant renal manifestation. Study 2 evaluated the impact of different classes of nephritis on maternal and fetal gestational outcomes. It was concluded that pregnant women with proliferative nephritis (classes III / IV) presented more frequently disease activity during pregnancy, continuous active disease during pregnancy and the puerperium, hospitalization, cesarean section and PE compared to patients without nephritis, also with higher fetal morbidity compared to pregnant women with nonproliferative nephritis (classes II and V). In study 3, analysis of serum levels of angiogenic (VEGF, PlGF) and antiangiogenic (sFlt-1) factors was performed in pregnant women with SLE and inactive disease, active renal disease and PE. It was shown that pregnant women with SLE who develop PE had statistically significant elevation in sFlt-1 and lower levels of PlGF, the same pattern as PE patients without SLE. Patients with active nephritis had increased VEGF compared to the other two groups, suggesting the potential use of these markers in clinical practice for differentiation between PE and lupus nephritis.