Análise da ocorrência de recém-nascidos pequenos para idade gestacional em mulheres com lúpus eritematoso sistêmico em uma unidade de referência do Estado de Rio de Janeiro

Abstract

Systemic lupus erythematosus (SLE) is associated with a higher risk of placental insufficiency and fetal growth restriction, leading to birth of small for gestational age (SGA) concepts, defined by birthweight below the 10th percentile. Fetuses with IUGR have 10 times higher neonatal mortality, higher risk of neonatal complications, delay in neurodevelopment and, in adulthood, hypertension, diabetes, hypercholesterolemia and cardiovascular disease. The present study aims to analyze the occurrence of SGA newborns (NB) in pregnant women with SLE accompanied at the University Hospital Pedro Ernesto between 2011 and 2016. We studied the association of birth of SGA infants with clinical and laboratory maternal characteristics prior to conception, during gestation and with maternal comorbidities. This is a cohort study with retrospective and prospective data collection, with inclusion of patients with 4 or more SLE classification criteria (ACR), single pregnancies and deliveries after 22 weeks. Newborns with congenital malformations or aneuploidy were excluded. Data were obtained by review of medical records guided by a semi-structured script. The comparison between groups was done by logistic regression and using Student's t-test or Mann-Whitney and chi-square test (χ2) or Fisher's exact, with significance of 5%. Of the 192 patients seen, 151 met the inclusion criteria. There were 28 patients with SGA NB (18.5%), 19 of these (67.9%) with birthweight below the 3rd percentile and / or altered fetal dopplervelocimetry (subgroup of greater severity). Of the pre-conception variables, previous history of nephritis (RR=3.01) and presence of anti-RNP antibody (RR=2.67) were more frequent in patients with SGA NB. Of the variables that occurred during gestation, active nephritis at conception (RR=2.93) and in gestation (RR=2.94), pulse therapy with methylprednisolone (RR=20.3) and consumption of C3 complement (RR=2.70) were associated with SGA group. Pulse therapy was an independent predictor for SGA birth in the multivariate analysis. Among SGA infants, fetal death (4.3 times) and neonatal intensive care unit admission (3.2 times) were more frequent and among women with SGA NB, activity in the puerperium (3.9 times) and peripartum hemorrhage (2.3 times). All of the above variables were statistically significant (p<0.05).